Canadian Syncope Risk Score

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Clinical Use

Predicts 30-day risk of serious adverse event in patients presenting with syncope

More Info

The Canadian Syncope Risk Score has been developed as a clinical predictor for a 30-day risk of serious adverse event, including death, arrhythmia, myocardial infarction, aortic dissection, pulmonary embolism and subarachnoid hemorrhage, in patient presenting in emergency department with syncope.
The data was derived from a prospective observational study based on six large Canadian emergency departments. Total 4,030 adults who presented within 24 hours of an event were included in the study.
There were 9 clinical predictors identified.

Category Points
Clinical evaluation
  Predisposition to vasovagal symptoms. Triggered by being in a warm crowded place, prolonged standing, fear, emotion or pain. -1
  History of heart disease 1
  Any systolic pressure reading <90 or >180 mmHg 2
Investigations
  Elevated troponin level (>99th percentile of normal population) 2
  Abnormal QRS axis (<-30° or >100°) 1
  QRS duration >130 ms 1
  Corrected QT interval >480 ms 2
Diagnosis in emergency department
  Vasovagal syncope -2
  Cardiac syncope 2

 
This resulted in a total score that ranges between -3 and 11. The risk was categorized as follows:

Total score Estimated risk of serious adverse event Risk category
-3 0.4% Very low
-2 0.7%
-1 1.2% Low
0 1.9%
1 3.1% Medium
2 5.1%
3 8.1%
4 12.9% High
5 19.7%
6 28.9% Very high
7 40.3%
8 52.8%
9 65.0%
10 75.5%
11 83.6%

 
The score is currently undergoing validation. Once validated, it can be used to guide disposition decisions in the emergency department setting.

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References

1. Thiruganasambandamoorthy V, Kwong K, Wells GA, et al. Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope. CMAJ. 2016;188(12):E289-98. Full text

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