The San Francisco Syncope Rule performs well in a regional rural emergency department in New Zealand.

AIMS: To assess the utility of a decision rule for determining short-term risk in syncope patients presenting to the Emergency Department (ED) of Nelson Hospital (Nelson, New Zealand). METHODS: Sixty-eight of 83 eligible syncope patients who presented to the ED with syncope were consecutively enrolled. Follow-up for an adverse event within 7 days of index presentation was performed. Actual event rate was compared with the prediction tool known as the San Francisco Syncope Rule (SFSR). RESULTS: Sensitivity and specificity for the SFSR was 83% (95% Confidence Interval (CI) of 44-97%) and 82% (95%CI 71-91%) respectively. There was a negative predictive value of 98% (95% CI 90-99%). Positive and negative likelihood ratios were 4.7 (95% CI 2.5-9.0) and 0.2 (95% CI 0.03-01.22) respectively. CONCLUSION: Syncope patients who present to the ED with no obvious cause and who are being considered for discharge may benefit from application of the SFSR for short-term risk assessment.