Interpretation
| Result | Meaning |
|---|---|
| Any criterion | Not low risk: consider admission/further work-up |
| None | Low risk for 7-day serious outcome |
Formula
C: history of CHF · H: Hct <30% · E: abnormal ECG (non-sinus rhythm or new changes) · S: shortness of breath · S: triage SBP <90 mmHg. Any = not low risk.
Clinical pearls
- Derivation: 684 consecutive ED visits for syncope or near-syncope at one US academic centre; serious outcomes = death, MI, arrhythmia, PE, stroke, SAH, significant haemorrhage or return ED visit with hospitalisation within 7 days.
- External validations have shown lower sensitivity (around 85–90%); use as an adjunct, not as the sole basis for discharge.
- Patients with obvious alternative causes (seizure, trauma-induced LOC, intoxication) were excluded.
Examples
sf syncope rule: no chf, hct 38, normal ecg, no sob, sbp 120syncope 70 yo with heart failure, hematocrit 35%, BP 110, ECG shows AF
FAQ
What does CHESS stand for?
CHF history, Hematocrit <30%, ECG abnormal, Shortness of breath, Systolic BP <90 at triage.
Is the SF Syncope Rule better than the Canadian Syncope Risk Score?
The Canadian Syncope Risk Score was derived in a larger multicentre cohort with 30-day outcomes and gives graded risk; the SF rule is a simpler binary screen.