MDCalc

Boston Syncope Criteria

Assesses the risk of adverse events among patients presenting to the emergency department with syncope.

Signs and symptoms of acute coronary syndrome

Signs of conduction disease

Worrisome cardiac history

Valvular heart disease

Family history of sudden death

Volume depletion

Abnormal vital signs

Persistent (>15 min) in the ED without the need of concurrent interventions such as oxygen, pressors, or temporary pacemaker

Central nervous system

Diagnostic Result

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Advice
  • Use results in conjunction with clinical judgment and a thorough investigation.
  • Be sure to exclude syncope mimics (e.g., seizure, hypoglycemia, intoxication).
Management
  • No criteria are present:
    • The patient is likely low risk.
    • Consider discharge or brief observation with clear return precautions.
    • Ensure timely outpatient follow-up for additional evaluation.
  • Any criteria are present:
    • The patient is not low risk.
    • Admission for inpatient evaluation is appropriate for cardiac monitoring and targeted testing (based on the positive criterion domain and suspected underlying etiology).