Canadian Syncope Risk Score

Predicts 30-day serious adverse events in patients presenting with syncope.

INSTRUCTIONS
Applicable to patients ≥16 years old presenting ≤24 hours of syncope. Do not use if:
prolonged (>5 min) LOC, change in mental status from baseline, obvious witnessed
seizure, major trauma, intoxication, language barrier, or head trauma causing LOC.
This calculator is externally validated, according to data presented at the Society for
Academic Emergency Medicine Annual Meeting 2018.
When to Use

 Patients ≥16 years old presenting ≤24 hours of syncope.

 Do not use in patients with any of the following:
o Prolonged (>5 min) LOC.
o Change in mental status from baseline.
o Obvious witnessed seizure.
o Major trauma requiring hospital admission.
o Intoxication with alcohol or illicit drugs.
o Language barrier.
o Head trauma causing LOC.

Pearls/ Pitfalls

 Predicts risk of 30-day serious adverse events associated with syncope,

defined as any of the following: death, arrhythmia, non-arrhythmic cardiac
causes, or non-cardiac causes (see Evidence for full list).
 In 2020, the CSRS was successfully validated (see Evidence, below).

Why Use

 Syncope is a common, often benign presenting complaint in emergency

departments, that sometimes has life-threatening underlying causes. The
Canadian Syncope Risk Score identifies patients with syncope who are at
higher risk of adverse outcomes.
 Can potentially avoid unnecessary investigation and/or admission.

ABOUT THE CREATOR

Venkatesh Thiruganasambandamoorthy, MBBS, CCFP-EM, MSc, is an emergency
physician and associate professor in the department of emergency medicine and
epidemiology / community medicine at the Ottawa Hospital Research Institute in
Ottawa, Canada. He heads the Venk Group, a research program that aims to reduce
morbidity and mortality from syncope and pre-syncope using robust risk-stratification,
particularly for identifying low-risk patients. Dr. Thiruganasambandamoorthy is a
founding member of the Canadian Syncope Alliance, a national collaboration aiming
to improve syncope care in Canada.
Tabel Analisa Masing-Masing Skoring
Luaran
Penelitian Populasi Variabel Prediktor Validasi
Pengukruan
Boston Populasi Tanda penurunan Intervensi Internal:
Syncope asal: A volume. kritikal atau Sensitivitas
Rule, 2007 priori Tanda vital abnormal kejadian yang (Se) 97%;
(Risiko di IGD. tidak Spesifisitas
jangka Validasi: Tanda dan gejala diinginkan (Sp) 62%
Pendek) 362 sindrom koroner akut. (KTD) dalam
pasien Tanda dan gejala 30 hari. Eksternal: -
gangguan konduksi.
Riwayat penyakit
jantung.
Riwayat kematian
mendadak pada
keluarga.
Kejadian gangguan
sistem saraf pusat
pertama kali.
Penyakit katup
jantung.

Canadian Populasi Predisposisi sinkop Komplikasi Internal:

Syncope asal: vasovagal serius dalam 30 Sensitivitas
Rule, 2016 4.030 (prodromal/pemicu). hari: Kematian, (Se) 97,8%;
(Risiko pasien Riwayat penyakit aritmia, infark Spesifisitas
jangka jantung. miokard, (Sp) 44,3%
Pendek) Validasi: Tekanan darah sistolik emboli paru,
3.819 <90 atau >180 mmHg. diseksi aorta, Eksternal:
pasien Peningkatan troponin. stroke, atau Sensitivitas
Aksis QRS abnormal. intervensi lebih rendah
Durasi gelombang prosedural
QRS. untuk sinkop.
Interval QT.
Diagnosis IGD
mengarah ke sinkop
vasovagal/kardiak

EGSYS Populasi Riwayat Palpitasi. Probabilitas Internal:

Score, asal: 260 EKG abnormal atau sinkop Sensitivitas
2008 pasien riwayat penyakit kardiogenk (Se) 92%;
(Risiko jantung. dalam 2 tahun. Spesifisitas
jangka Validasi: Sinkop saat bergiat (Sp) 69%
Pendek 258 atau posisi supinasi.
dan jangka pasien Prodromal gejala Eksternal:
Panjang) otonom. Se 56% ; Sp
Faktor 84%
presipitasi/predisposisi.
OESIL Populasi Temuan EKG Mortalitas 1 Internal:
Risk Score, asal: 270 abnormal. tahun Sensitivitas
2003 pasien Tidak adanya gejala (Se) 100%;
(risiko prodromal. Spesifisitas
jangka Validasi: Usia >65 tahun. (Sp) 22%
Panjang) 328 Riwayat penyakit
pasien jantung. Eksternal:
Se 95% ; Sp
31%
ROSE Populasi Anemia (Hb ≤9 g/dl) Komplikasi Internal:
study, asal: 550 Bradikardi (<50 dalam 1 bulan: Sensitivitas
2010 pasien x/menit). Kematian, (Se) 87%;
(risiko Pengukuran Brain aritmia, infark Spesifisitas
jangka Validasi: Natriuretic Peptide. miokard, (Sp) 66%
pendek) 550 Nyeri dada dengan emboli paru, Hasil luaran
pasien sinkop. stroke, dalam 1
EKG menunjukkan perdarahan tahun: Se
gelombang Q subaraknoid, 72%; Sp
patologis. transfusi darah 71%
Saturasi oksigen. atau intervensi
Pemeriksaan rektal prosedural akut, Eksternal: -
untuk adanya pemasangan
perdarahan. pacu jantung.
San Populasi Abnrmalitas EKG. Komplikasi Internal:
Francisco asal: 684 Gagal jantung. serius dalam 7 Sensitivitas
Syncope pasien Hematkrit <30. hari: (Se) 98%;
Rule, 2004 Sesak nafas. sindromkoroner Spesifisitas
(risiko Validasi: Tekanan darah sistolik akut, emboli (Sp) 56%
jangka 791 <90 mmHg paru, stroke,
pendek) pasien aritmia, Eksternal:
perdarahan Se 87% ; Sp
subarknoid, 52%
kunjungan IGD
berulang, re-
admisi.