Canadian Syncope Risk Score

Predisposition to vasovagal symptoms (reassuring)

History of clinically significant heart disease

Any systolic BP reading <90 or >180 mmHg in the ED

Elevated troponin (above normal for local assay)

Abnormal QRS axis (<-30 or >100 degrees)

QRS duration >130 ms

Corrected QT interval >480 ms

ED diagnosis of vasovagal syncope

ED diagnosis of cardiac syncope

Result0 points

Approximate 30-day risk of a serious adverse event is very low (<=0.9%).

30-day serious adverse event risk: very low (<=0.9%)

When to use

Risk-stratifying adult emergency department patients with syncope for 30-day serious adverse events, including arrhythmia and death.

Formula

Sum of: predisposition to vasovagal symptoms (-1), heart disease history (+1), SBP <90 or >180 mmHg (+2), elevated troponin (+2), abnormal QRS axis (+1), QRS duration >130ms (+1), QTc >480ms (+2), ED diagnosis of vasovagal syncope (-2), ED diagnosis of cardiac syncope (+2). Range -3 to +11.

References

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.