The Cardiovascular
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ROSE (Risk Stratification of Syncope in the Emergency Department) Rule

Predicts 1-month serious outcomes after ED syncope.

ROSE (Risk Stratification of Syncope in the Emergency Department) Rule
BNP ≥300 pg/mL
Bradycardia ≤50 bpm
Rectal exam positive for occult blood
Hemoglobin ≤9 g/dL
Chest pain associated with syncope
Q wave on ECG (not in lead III)
Oxygen saturation ≤94% on room air
Result0 of 7 criteria positive

No criteria present — low risk for a serious outcome within 1 month.

When to use

  • Deciding whether a patient with syncope in the ED needs admission or further urgent work-up.

Formula

High risk if any one of 7 criteria (BRACES) present: BNP ≥300, bradycardia ≤50, occult blood positive, Hb ≤9 g/dL, chest pain, ECG Q wave, SpO2 ≤94%.

References

  1. Reed MJ, et al. J Am Coll Cardiol. 2010;55(8):713-21.