Move Over San Francisco – Canadian Syncope Score Validated

May 21, 2020

Written by Vivian Lei

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The Canadian Syncope Risk Score (CSRS) was successfully validated as a tool to risk stratify ED patients presenting with acute syncope.  Patients at low risk for serious outcomes at 30 days can be safely discharged.

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Why does this matter?
A patient presenting to the ED with syncope is often hospitalized unnecessarily when no obvious serious underlying condition is identified. This study is a prospective validation of the Canadian Syncope Risk Score which is a promising decision tool for emergency physicians confronted with determining patient risk for serious outcomes.

Disposition: Syncope
In this multicenter prospective cohort validation study performed in 9 Canadian EDs, patients age 16 and older presenting for syncope were enrolled and evaluated with CSRS. They excluded patients who had prolonged LOC (>5 minutes), witnessed seizure, mental status changes, head trauma causing LOC, major trauma, inability to provide a history, or another serious outcome identified prior to ED disposition. Through review of medical records, phone calls, and death records, patients were followed for 30 days for serious outcomes (i.e. death due to any cause, arrhythmic outcomes, and non-arrhythmic outcomes). Of the 3,819 patients, 139 (3.6%) had a serious outcome within 30 days. Only 3 (0.3%) out of 1,631 patients at very low risk and 9 (0.7%) of 1,254 patients at low risk experienced serious 30-day outcomes. None of those patients died or had ventricular arrhythmia. Comparatively, 19.2% of the high risk and 51.3% of the very high risk groups experienced serious 30-day outcomes. This risk stratification tool appears clinically useful in supporting ED disposition and may additionally be helpful in discussing risk estimates with patients during shared decision making in the ED.

Source
Multicenter Emergency Department Validation of the Canadian Syncope Risk Score.  JAMA Intern Med. 2020 Mar 23. doi: 10.1001/jamainternmed.2020.0288. [Epub ahead of print]

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