Bedside Rounds

Canadian Syncope Risk Score

The Canadian Syncope Risk Score uses history, ED blood pressure, troponin, ECG findings and the ED diagnosis to estimate the 30-day risk of serious outcomes such as arrhythmia, MI or death.

What goes into the Canadian Syncope Risk Score

  • Predisposition to vasovagal symptoms (warm crowded place, prolonged standing, fear, emotion, pain) (+-1)
  • History of heart disease (+1)
  • Any SBP < 90 or > 180 mmHg in ED (+2)
  • Troponin above the 99th percentile (+2)
  • Abnormal QRS axis (< −30° or > 100°) (+1)
  • QRS duration > 130 ms (+1)
  • Corrected QT > 480 ms (+2)
  • ED diagnosis: Neither (0); Vasovagal syncope (-2); Cardiac syncope (2)

How to interpret the result

  • −3 to −2: very low risk
  • −1 to 0: low risk
  • 1 to 3: medium risk
  • 4 to 5: high risk
  • ≥ 6: very high risk

Clinical pearls

  • Low-risk patients can usually be discharged without further testing.
  • Medium- and high-risk patients may benefit from short cardiac monitoring; most arrhythmias show within 2–6 hours.
  • Validated in adults presenting within 24 hours of syncope.

Evidence

  1. Thiruganasambandamoorthy V, et al. Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope. CMAJ. 2016;188:E289-E298.

Related workups

SyncopeSymptomatic bradycardia and heart blockAcute dizziness and vertigo

Related calculators

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For education only. Check the inputs and the population the score was validated in before acting on it. Not a substitute for clinical judgment.