Canadian Syncope Risk Score

Subscribe to Resus

Get the latest updates on our Conferences PLUS our Webcasts and Education Newsletters. And it's FREE!

  • We respect your privacy
  • This field is for validation purposes and should be left unchanged.

Register Now:

Emcore
Learn More

Those Canadians are clever. They’ve given us ankle rules and knee rules and subarachnoid rules. Now a Syncope Risk Score.

In 2016 the first Canadian Syncope Risk Rule was published. The aim was to predict 30 day serious outcomes. In 2020 they validated the score. Sort of….

It was really an internal validation, conducted in Canada. The next step would be a validation of the score outside of Canada.

Here is the summary of the score.

The Canadian Syncope Risk Score has multiple variables shown below with a score that can range from -3 to 11. The lower the score, the lower the risk.

a  Triggered by being in a warm crowded place, prolonged standing, fear, emotion, or pain.
b  lncludes coronary or valvular heart disease, cardiomyopathy, congestive heart failure, and nonsinus rhythm (electrocardiogram evidence during index visit or documented history of ventricular or atrial arrhythmias, or device implantation).
c  Includes blood pressure values from triage until disposition from the emergency department.

What They Did

Prospective Cohort Validation Study

9 Large Canadian Emergency Departments

n=3819

30 day serious outcomes were specified as:

  • arrhythmic serious conditions
    • any serious arrhythmias;
    • intervention to treat arrhythmias such as pacemaker/ defibrillator insertion, or cardioversion; or
    • any death due to an unknown cause) or
  • nonarrhythmic serious conditions
    • myocardial infarction,
    • serious structural heart disease,
    • aortic dissection,
    • pulmonary embolism,
    • severe pulmonary hypertension,
    • significant hemorrhage,
    • subarachnoid hemorrhage,
    • or any other serious condition causing syncope).

Results

Very Low and Low Risk Patients

  • < 1% experienced a 30 day serious outcome

Very High Risk Groups

  • 51% experienced 30-day serious outcomes.
CMAJ. 2016;188(12):E289-E298. The original scoring system.

Let’s look at some hypothetical cases

Case 1
A 72 yo patient presents with a syncopal episode. There are only minor injuries ie., scratches. The patient has no recollection of the event and there was no prodromal syndrome.
The patient’s past medical history includes hypertension, diabetes. Examination is normal and the ECG is normal.
What does the patient score?
This patient scores a 2. This falls into the medium risk category and attracts a 5% risk of a 30 day serious outcome. I’m not comfortable with discharging this patient.

Case 2
If we change one thing in this scenario and say that the patient has a history of atrial fibrillation. This raises the score to a 3 and the risk to 8.1%.

Case 3
If we keep the patient’s history the same ie., hypertension and diabetes, but change this to a clear vagal episode, with prodrome and diaphoresis after standing for a long period of time and still keep the atrial fibrillation on the ECG, the score now is -1 ie a 1.2% risk of a serious outcome.

Conclusion

Three-quarters of patients in this validation study were very low or low risk. No patients in these groups died nor experienced ventricular arrhythmias. This means a very low risk of adverse event if the patient is sent home.

The good thing about this scoring system is that negative marks can be scored. The bad, is that a troponin needs to be done.

If a patient has had a clear vasovagal episode that was triggered by known vasovagal triggers and has no other history, with a normal ECG, they will probably only score a -3 and are very low risk, but we still need to perform a troponin.

I don’t feel comfortable with sending patients home if their risk is >2%, so there is nothing that changes my management. If they are elderly and have significant past history, or have an abnormal ECG, or no features of a vagal episode, I’ll be admitting most of them.

What a score like this does, is give us an evidence-based backup for what we do. Let’s hope the external validation comes soon.

Posted in ,

Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator resus.com.au.

46 Comments

  1. Jill on 06/10/2021 at 7:10 am

    I blog quite often and I truly appreciate your content.

    This great article has truly peaked my interest. I’m going to book mark your website and keep checking for new details
    about once per week. I opted in for your Feed as well.

  2. hair growth on 06/10/2021 at 7:11 am

    Hi, Neat post. There’s an issue together with your website in internet explorer,
    would test this? IE nonetheless is the market leader
    and a huge component of other people will pass over your fantastic writing
    because of this problem.

    Also visit my website; hair growth

  3. improving sex on 06/10/2021 at 7:12 am

    My family all the time say that I am wasting my time here at web,
    but I know I am getting know-how all the time by reading thes nice content.

    Feel free to surf to my webpage :: improving sex

  4. natural skin care tips for dry skin on 06/10/2021 at 7:17 am

    I will immediately clutch your rss as I can not in finding your
    email subscription hyperlink or newsletter service. Do you’ve any?

    Kindly allow me understand in order that I may subscribe. Thanks.

    Here is my web blog – natural skin care tips for dry skin

  5. Etta on 06/10/2021 at 7:32 am

    Howdy! Do you know if they make any plugins to assist
    with Search Engine Optimization? I’m trying to get my blog to
    rank for some targeted keywords but I’m not seeing very good success.
    If you know of any please share. Many thanks!

    Also visit my web blog :: stop weed smoking (Etta)

  6. www.aniene.net on 06/10/2021 at 7:49 am

    What’s up to every body, it’s my first go to
    see of this webpage; this blog carries awesome and really fine stuff designed for visitors.

    Look at my web-site :: make healthy eating (http://www.aniene.net)

  7. dry skin care on 06/10/2021 at 8:11 am

    I always spent my half an hour to read this weblog’s articles all the time along with a
    cup of coffee.

    Also visit my page; dry skin care

  8. rueangseaw.com on 06/10/2021 at 8:22 am

    you are really a good webmaster. The website loading speed is amazing.
    It seems that you’re doing any unique trick.
    Moreover, The contents are masterwork. you have done a great
    activity in this topic!

    Feel free to surf to my blog testosterone therapy (rueangseaw.com)

  9. fat loss diets on 06/10/2021 at 8:40 am

    Unquestionably believe that which you said. Your favorite justification appeared to be on the
    web the easiest thing to be aware of. I say to you,
    I certainly get annoyed while people consider worries that they just do not know
    about. You managed to hit the nail upon the top as well as defined
    out the whole thing without having side effect , people can take a signal.
    Will likely be back to get more. Thanks

    Also visit my web site; fat loss diets

  10. cannabis seeds on 06/10/2021 at 8:57 am

    F*ckin’ tremendous things here. I am very happy to see your post.
    Thank you so much and i’m looking ahead to contact you.
    Will you please drop me a mail?

    Here is my page; cannabis seeds

  11. http://www.fotosombra.com.br on 06/10/2021 at 8:59 am

    I used to be able to find good info from your content.

    Feel free to surf to my page: sciatic nerve reliefsciatic treatment (http://www.fotosombra.com.br)

  12. diet solution program on 06/10/2021 at 9:09 am

    I’m very happy to read this. This is the type of manual that needs to be given and not the random misinformation that’s at the other blogs.
    Appreciate your sharing this best doc.

    my web page :: diet solution program

  13. fat loss diet on 06/10/2021 at 9:32 am

    Heya! I just wanted to ask if you ever have any trouble with hackers?
    My last blog (wordpress) was hacked and I ended up losing months of hard work
    due to no back up. Do you have any methods to protect against
    hackers?

    Take a look at my page :: fat loss diet

  14. healthy meal plans on 06/10/2021 at 9:44 am

    Hi, i think that i noticed you visited my
    web site so i came to ?return the desire?.I am attempting to
    to find things to improve my web site!I assume its adequate to make use of some of your ideas!!

    my homepage … healthy meal plans

  15. Hello there, just became aware of your blog through Google,
    and found that it is really informative. I?m going to watch out for
    brussels. I will appreciate if you continue this in future.
    A lot of people will be benefited from your writing. Cheers!

    my page low carb diet (http://forum.chrisricard.net/index.php?action=profile;u=68237)

  16. Hi there just wanted to give you a quick heads up.
    The words in your article seem to be running off the screen in Opera.
    I’m not sure if this is a format issue or something
    to do with web browser compatibility but I figured
    I’d post to let you know. The layout look great though!
    Hope you get the issue fixed soon. Many thanks

    Here is my blog: cannabis dispensaries-san – https://tanhua666.com/home.php?mod=space&uid=892216&do=profile&from=space,

  17. slot android on 06/10/2021 at 9:58 am

    Hi it’s me, I am also visiting this web page regularly, this web
    site is actually good and the viewers are actually sharing good thoughts.

  18. balanced diet on 06/10/2021 at 10:27 am

    Oh my goodness! Incredible article dude! Thanks, However I am experiencing troubles with your RSS.
    I don’t understand the reason why I am unable
    to subscribe to it. Is there anybody having similar RSS issues?
    Anyone who knows the solution will you kindly respond?

    Thanks!!

    Here is my webpage … balanced diet

  19. low carb on 06/10/2021 at 10:28 am

    Wow! This could be one particular of the most beneficial blogs We have ever
    arrive across on this subject. Actually Excellent. I’m also an expert in this topic so I can understand your effort.

    My web site :: low carb

  20. healthy meal plans on 06/10/2021 at 10:51 am

    I am regular reader, how are you everybody? This piece of writing posted at
    this web page is really pleasant.

    Look into my homepage: healthy meal plans

  21. healthy meal plans on 06/10/2021 at 11:27 am

    Article writing is also a excitement, if you be familiar with after that you can write otherwise it is complicated to write.

    Here is my site: healthy meal plans

  22. 163.30.42.16 on 06/10/2021 at 12:43 pm

    I’m curious to find out what blog system you are utilizing?
    I’m having some minor security issues with my latest website and I would like to find something
    more secure. Do you have any recommendations?

    Review my web site :: healthy diet – 163.30.42.16

  23. 163.30.42.16 on 06/10/2021 at 12:45 pm

    I loved as much as you’ll obtain performed proper here. The comic strip is tasteful, your authored
    material stylish. nevertheless, you command get
    bought an shakiness over that you wish be handing over the following.
    in poor health without a doubt come further previously once more since precisely the similar just about
    a lot steadily inside of case you shield this hike.

    My webpage – how to stop smoking weed [163.30.42.16]

  24. http://www.fotosombra.com.br/ on 06/10/2021 at 12:55 pm

    I need to to thank you for this wonderful read!!
    I certainly enjoyed every bit of it. I’ve got you saved
    as a favorite to check out new stuff you post…

    My web site acne treatment reviews – http://www.fotosombra.com.br/

  25. www.aniene.net on 06/10/2021 at 1:49 pm

    Spot on with this write-up, I actually believe this amazing site
    needs far more attention. I?ll probably be returning fasting
    to lose weight (http://www.aniene.net) read more, thanks for the advice!

  26. 163.30.42.16 on 06/10/2021 at 1:59 pm

    Very good info. Lucky me I ran across your blog by chance (stumbleupon).
    I’ve saved it for later!

    Also visit my webpage … marketing online, 163.30.42.16,

  27. hatched seeds on 06/10/2021 at 1:59 pm

    We would like to thank you all over again for the gorgeous ideas you gave Jesse when preparing her own post-graduate research and also, most
    importantly, with regard to providing all the ideas within a blog post.
    In case we had known of your website a year ago, i’d have been saved the unnecessary measures we were employing.
    Thanks to you.

    my web blog :: hatched seeds

  28. muscle growth on 06/10/2021 at 2:14 pm

    I needed to post you the very small note to
    be able to give many thanks once again with your incredible
    techniques you have discussed above. It was pretty generous of
    you to grant unreservedly exactly what a lot of people might have advertised for an e
    book to generate some cash for their own end, particularly considering the fact that you could possibly have done it if you ever wanted.
    Those basics in addition acted to be a good way to comprehend most people have similar zeal just like my personal own to see more
    in regard to this issue. I am sure there are
    some more enjoyable sessions ahead for individuals who read carefully your blog.

    Here is my web-site muscle growth

  29. acne treatment on 06/10/2021 at 2:16 pm

    There is apparently a bundle to know about this.

    I believe you made some good points in features also.

    Here is my web blog: acne treatment

  30. brace company near crest hill on 06/10/2021 at 3:26 pm

    Excellent beat ! I wish to apprentice while you amend your website, how can i subscribe
    for a weblog web site? The account helped me a applicable deal.
    I had been tiny bit acquainted of this your broadcast offered vivid transparent idea

    Here is my page :: brace company near crest hill

  31. first time sex tips on 06/10/2021 at 3:37 pm

    Hey There. I found your blog using msn. This is a really well written article.
    I’ll make sure to bookmark it and return to read more of your useful information. Thanks for the post.
    I will definitely return.

    My web blog :: first time sex tips

  32. judi slot uang asli on 06/10/2021 at 3:58 pm

    Hi! I’m at work surfing around your blog from my new iphone 3gs!

    Just wanted to say I love reading your blog and look forward to all your posts!
    Carry on the great work!

  33. indoor growing on 06/10/2021 at 4:22 pm

    Thank you for sharing your info. I truly appreciate your efforts and I am waiting for your
    next write ups thanks once again.

    Look into my page – indoor growing

  34. umraniyescort.net on 06/10/2021 at 4:55 pm

    I have to thank you for the efforts you’ve put in penning this
    website. I really hope to see the same high-grade content from you in the future
    as well. In fact, your creative writing abilities has inspired me to get my very own website now 😉

  35. Sterling on 06/10/2021 at 6:04 pm

    I’m not that much of a online reader to be honest but your sites really nice, keep it up!
    I’ll go ahead and bookmark your site to come back later.

    Cheers

  36. attractive skin on 06/10/2021 at 6:55 pm

    Hello there, just become alert to your weblog thru Google, and located that
    it’s truly informative. I am going to watch out for
    brussels. I will be grateful when you continue this in future.
    Lots of other people can be benefited out of your writing.
    Cheers!

    My web blog … attractive skin

  37. Soon on 06/10/2021 at 7:10 pm

    Hello my loved one! I want to say that this post is amazing, great written and come with
    almost all important infos. I would like to look more posts like this .

  38. forum.m2clasic.ro on 06/10/2021 at 10:30 pm

    I always spent my half an hour to read this blog’s content all the time along with a cup
    of coffee.

    Also visit my blog poor eating habits [forum.m2clasic.ro]

  39. Troy on 07/10/2021 at 2:22 am

    Hey there! I know this is kinda off topic however
    , I’d figured I’d ask. Would you be interested in trading links or maybe guest authoring a
    blog post or vice-versa? My website discusses a lot of the same subjects as yours and I think we could greatly benefit from each
    other. If you happen to be interested feel free to send me an email.
    I look forward to hearing from you! Superb blog by the way!

  40. Marisa on 07/10/2021 at 2:54 am

    Hello there! This blog post could not be written much better!
    Reading through this post reminds me of my previous roommate!

    He constantly kept preaching about this. I most
    certainly will send this information to him. Pretty sure he’ll have a good read.
    Thank you for sharing!

  41. https://www.kuwaitibazaar.com on 07/10/2021 at 6:30 am

    This design is incredible! You obviously know
    how to keep a reader entertained. Between your wit and your videos, I was almost moved to start
    my own blog (well, almost…HaHa!) Fantastic job. I really enjoyed what you had
    to say, and more than that, how you presented it. Too cool!

  42. Raphael on 07/10/2021 at 7:49 am

    I don’t even know how I ended up here, but I thought
    this post was good. I don’t know who you are but definitely you’re going to a famous blogger
    if you are not already 😉 Cheers!

  43. Angie on 07/10/2021 at 8:53 am

    Fantastic beat ! I wish to apprentice at the same time as you
    amend your web site, how can i subscribe for a blog web site?
    The account helped me a appropriate deal. I have been a little bit familiar of this your broadcast provided shiny clear idea

  44. Grant on 07/10/2021 at 11:07 am

    Hurrah! At last I got a web site from where I be capable of in fact obtain helpful data regarding my study and knowledge.

  45. carslot88 agen judi slot on 07/10/2021 at 11:57 am

    I used to be able to find good info from your content.

  46. buy dmt online on 09/10/2021 at 9:51 pm

    794667 441888I discovered your blog internet web site on bing and appearance several of your early posts. Preserve up the quite great operate. I just now additional the RSS feed to my MSN News Reader. Seeking toward reading far a lot more on your part down the road! 704553

Leave a Comment