Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    Canadian Syncope Risk Score

    Predicts 30-day serious adverse events in patients presenting with syncope.
    Favorite

    INSTRUCTIONS

    Applicable to patients ≥16 years old presenting ≤24 hours of syncope. Do not use if: prolonged (>5 min) LOC, change in mental status from baseline, obvious witnessed seizure, major trauma, intoxication, language barrier, or head trauma causing LOC. This calculator is externally validated, according to data presented at the Society for Academic Emergency Medicine Annual Meeting 2018.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients ≥16 years old presenting ≤24 hours of syncope.
    • Do not use in patients with any of the following:
      • Prolonged (>5 min) LOC.
      • Change in mental status from baseline.
      • Obvious witnessed seizure.
      • Major trauma requiring hospital admission.
      • Intoxication with alcohol or illicit drugs.
      • Language barrier.
      • Head trauma causing LOC.
    • Predicts risk of 30-day serious adverse events associated with syncope, defined as any of the following: death, arrhythmia, non-arrhythmic cardiac causes, or non-cardiac causes (see Evidence for full list).
    • Not yet externally validated.
    • Syncope is a common, often benign presenting complaint in emergency departments, that sometimes has life-threatening underlying causes. The Canadian Syncope Risk Score identifies patients with syncope who are at higher risk of adverse outcomes.
    • Can potentially avoid unnecessary investigation and/or admission.

    Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights

    Advice

    Patients at medium or high risk (≥1 point) should undergo further investigation for cardiac and non-cardiac causes of syncope.

    Formula

    Addition of the selected points:

    Category

    Points

    Clinical evaluation

     

    Predisposition to vasovagal symptoms*

    -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

    *Triggered by being in a warm crowded place, prolonged standing, fear, emotion or pain.

    Facts & Figures

    Interpretation:

    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%

    **Death, arrhythmia, myocardial infarction, serious structural heart disease, aortic dissection, pulmonary embolism, severe pulmonary hypertension, severe hemorrhage, subarachnoid hemorrhage, or any other serious condition causing syncope and procedural interventions for the treatment of syncope.

    Evidence Appraisal

    The Canadian Syncope Risk Score was derived by Thiruganasambandamoorthy et al in a prospective cohort study based on six large Canadian emergency departments. 4,030 patients with syncope were enrolled (mean age was 53.6 years, 55.5% women).

    43 predictors of serious adverse events were studied, with nine being included in the final model. “Serious adverse event” was defined as death, arrhythmia, myocardial infarction, serious structural heart disease, aortic dissection, pulmonary embolism, severe pulmonary hypertension, severe hemorrhage, subarachnoid hemorrhage, or any other serious condition causing syncope and procedural interventions for the treatment of syncope.  3.6% of patients sustained a serious adverse event within 30 days of disposition from the ED.

    On internal validation, scores of -2 or higher were found to have sensitivity 99% and specificity 26%. Scores of -1 or higher had sensitivity 98%, specificity 46%.

    A prospective validation of the score has been completed and is pending publication.

    Dr. Venkatesh Thiruganasambandamoorthy

    About the Creator

    Venkatesh Thiruganasambandamoorthy, MBBS, CCFP-EM, MSc, is an emergency physician and associate professor in the department of emergency medicine and epidemiology / community medicine at the Ottawa Hospital Research Institute in Ottawa, Canada. He heads the Venk Group, a research program that aims to reduce morbidity and mortality from syncope and pre-syncope using robust risk-stratification, particularly for identifying low-risk patients. Dr. Thiruganasambandamoorthy is a founding member of the Canadian Syncope Alliance, a national collaboration aiming to improve syncope care in Canada.

    To view Dr. Venkatesh Thiruganasambandamoorthy's publications, visit PubMed

    Content Contributors
    • Thomas Yang, MD
    • Eric Steinberg, DO
    Content Contributors
    • Thomas Yang, MD
    • Eric Steinberg, DO