Thiruganasambandamoorthy et al reported the Canadian Syncope Risk Score for evaluating a patient in the Emergency Room with syncope. The authors are from the University of Ottawa, Queen's University, University of Alberta and the University of Calgary.
Patient selection: syncope in the Emergency Department
Outcome: serious adverse event within 30 days (death, arrhythmia, myocardial infarction, serious structural heart disease, aortic dissection, pulmonary embolism, pulmonary hypertension, severe hemorrahge, subarachnoid hemorrhage, other)
Parameters:
(1) predisposition to vasovagal symptoms (triggered by warm crowded place, prolonged standing, feat, emotion, pain)
(2) history of heart disease
(3) systolic blood pressure in mm Hg
(4) serum troponin concentration
(5) QRS axis on the ECG
(6) QRS duration in milliseconds
(7) corrected QT interval in milliseconds
(8) 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 |
2 |
|
|
any reading > 180 mm Hg |
2 |
|
|
between 90 and 180 |
0 |
|
serum troponin |
<= 99th percentile for population |
0 |
|
|
> 99th percentile |
2 |
|
QRS axis |
< -30° or > 100° |
1 |
|
|
from -30 to 100° |
0 |
|
QRS duration |
<= 130 ms |
0 |
|
|
> 130 ms |
1 |
|
corrected QT intreval |
<= 480 ms |
0 |
|
|
> 480 ms |
2 |
|
syncope diagnosis in ED |
vasovagal |
-2 |
|
|
cardiac |
2 |
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: -3
• maximum score: 11
• The higher the score the greater the risk for adverse events.
• A score >= 6 was considered very high risk.
• A score of 4 or 5 is considered high risk.
• A score of 1 to 3 is considered medium risk.
• A score of -1 or 0 is considered low risk while -2 or -3 is very low risk.
|
Score |
Serious Adverse Event |
|
-3 |
0.4% |
|
-2 |
0.7% |
|
-1 |
1.2% |
|
0 |
1.9% |
|
1 |
3.1% |
|
2 |
5.1% |
|
3 |
8.1% |
|
4 |
13% |
|
5 |
20% |
|
6 |
29% |
|
7 |
40% |
|
8 |
53% |
|
9 |
65% |
|
10 |
76% |
|
11 |
84% |
Specialty: Neurology
