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:

Sorry, we couldn't find any posts. Please try a different search.

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


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).


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.


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


  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. 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

  3. 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)

  4. 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 (

  5. 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

  6. 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 (

  7. 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

  8. 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 (;u=68237)

  9. 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

  10. 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 []

  11. 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 –

  12. 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,,

  13. 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

  14. 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

  15. 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

  16. 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.


  17. 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.

    My web blog … attractive skin

  18. 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 []

  19. 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

  20. 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.

  21. 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