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Risk score for predicting short-term outcomes of unexplained syncope patients

30-day prediction of adverse events.Credits: Kirsty Challen, Lancashire Teaching Hospital

The Canadian Syncope Risk Score (CSRS) is an accurately validated predictive score for emergency department patients with unexplained syncope. These are the results of a study entitled “Multivariate Risk Scores for Predicting Short-Term Outcomes of Emergency Department Patients with Unexplained Syncope: A Systematic Review,” which will be published in the May issue. Academic emergency medicine (((AEM) Journal, peer-reviewed journal of the Society for Academic Emergency Medicine (SAEM).

Syncope is a common presentation to the emergency department and patients are at risk of experiencing adverse events within 30 days. Without a standardized risk stratification system for patients, medical disparities and inconsistent patient care can occur and result in poor results.

Overall, this systematic review provides an up-to-date qualitative overview of the accuracy of the nine risk stratification scores in adult patients after a syncope event. Many scores in the study have not been validated or are not accurate enough for clinical use. Other risk scores were not validated in a separate sample, had a low positive likelihood ratio to identify high-risk patients, or had a high negative likelihood ratio to identify low-risk patients. ..

Although longer-term studies are needed before changing the guidelines, the Canadian syncope risk score was the most accurate in classifying patients at low and high risk of adverse events. This provides a promising ability to assist a physician in deciding whether a patient should justify an additional work-up or hospitalization. Further research is recommended as the impact on clinical decision-making, hospitalization rates, costs, or outcomes of care is unknown.

The lead authors of the report are Sunnybrook Health Sciences Center of Internal Medicine and Rachel AL Sweener (BMBS) of the University of Toronto School of Medicine in Toronto, Ontario, Canada.

Commenting on this study is an associate professor at Venkatesh Thiruganasambandamoorthy, CCFP-EM, MSc, School of Emergency Medicine and School of Epidemiology and Public Health, and a senior scientist at the Ottawa Hospital Institute. Dr. Thiruganasambandamoorthy is also the Chair of the Clinical Research Committee for Cardiovascular Emergency and a mid-career clinical researcher at the Physicians’ Services Incorporated Foundation.

“Although significant progress has been made in the stratification of syncope risk in the emergency department, this systematic review highlights the weaknesses of several previously published risk tools. Three major stages of development: Derivation, validation, and implementation. Implementations to demonstrate their true effect on patient care are the ultimate test of any clinical decision tool. ”


Long-term ECG monitoring of fainting ED patients is a safe alternative to hospitalization.


For more information:
Rachel AL Sweanor et al, Multivariate Risk Score for Predicting Short-Term Outcomes in Emergency Department Patients with Unexplained Syncope: Systematic Review, Academic emergency medicine (2020). DOI: 10.1111 / acem.14203

Provided by the Academic Emergency Medicine Society

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Risk score for predicting short-term outcomes of unexplained syncope patients

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