Thiruganasambandamoorthy et al reported the Canadian Syncope Arrhythmia Risk Score for evaluating a patient with syncope in the Emergency Department. The authors are from the University of Ottawa, the Ottawa Hospital, Queen's University Kingston, University of Alberta and University of Calgary.
NOTE: This score is based on the Canadian Syncope Risk Score from 2016.
Patient selection: Emergency Department with syncope
Parameters:
(1) predisposition to vasovagal symptoms (triggered by warm crowded place, prolonged standing, fear, emotion, pain)
(2) history of heart disease
(3) systolic blood pressure in mm Hg in the ED
(4) serum troponin concentration
(5) QRS duration in milliseconds
(6) corrected QT interval in milliseconds
(7) syncope diagnosis in emergency department
|
Parameter
|
Finding
|
Points
|
|
predisposition to vasovagal symptoms
|
no
|
0
|
|
|
yes
|
-1
|
|
history of heart disease
|
no
|
0
|
|
|
yes
|
1
|
|
systolic blood pressure
|
any reading < 90 mm Hg
|
1
|
|
|
any reading > 180 mm Hg
|
1
|
|
|
between 90 and 180
|
0
|
|
serum troponin
|
<= 99th percentile for population
|
0
|
|
|
> 99th percentile
|
1
|
|
QRS duration
|
<= 130 ms
|
0
|
|
|
> 130 ms
|
2
|
|
corrected QT interval
|
<= 480 ms
|
0
|
|
|
> 480 ms
|
1
|
|
syncope diagnosis in ED
|
vasovagal
|
-1
|
|
|
cardiac
|
2
|
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: -2
• maximum score: 8
|
Total Score
|
30-Day Risk of Serious Cardiac Arrhythmia
|
|
-2
|
0.2%
|
|
-1
|
0.5%
|
|
0
|
0.9%
|
|
1
|
1.9%
|
|
2
|
3.8%
|
|
3
|
7.5%
|
|
4
|
14.3%
|
|
5
|
25.4%
|
|
6
|
41.1%
|
|
7
|
58.8%
|
|
8
|
74.5%
|
Performance:
• The area under the ROC curve is 0.90.
