Table 1.3-5. Risk stratification scores after syncope

Canadian Syncope Risk Score

San Francisco Syncope Rule

OESIL risk score

Risk factors

– Predisposition to vasovagal symptoms (−1)

– Heart disease history (+1)

– SBP <90 or >180 mm Hg (+2)

– Elevated troponin (+2)

– Abnormal QRS axis (+1)

– QRS duration >130 ms (+1)

– Corrected QT interval >480 ms (+2)

– Vasovagal syncope (−2)

– Cardiac syncope (+2)

– SBP <90 mm Hg

– Shortness of breath

– ECG: nonsinus rhythm or new changes

– Hematocrit <30%

– Age >65 years

– History of CVD

– Syncope without prodrome

– Abnormal ECG findings

Assessed endpoint

30-day morbidity and mortality after presentation to ED:

7-day morbidity and mortality after presentation to ED:

1-year mortality:

– Score −3 to 0: 0.4%-1.9%

– Score 1-3: 3.1%-8.1%

– Score 4-5: 12.9%-19.7%

– Score 6-11: 28.9%-83.6%

– No factors present: 0.3%

– ≥1 factor present: 15.2%

– 0-1 factor (low risk): 0.6%

– 2-4 factors (high risk): 31%

Score accuracy

– Score ≥−2: Sensitivity 99%, specificity 26%

– Score ≥−1: Sensitivity 98%, specificity 46%

– Sensitivity 98%

– Specificity 56%

– LR+: 2.9

– LR−: 0.03

– Sensitivity 97%

– Specificity 73%

– LR+: 3.6

– LR−: −0.11

Adapted from CMAJ. 2016;188(12):E289-98, Ann Emerg Med. 2004;43(2):224-32, and Eur Heart J. 2003;24(9):811-9.

CVD, cardiovascular disease; ECG, electrocardiography; ED, emergency department; LR+, positive likelihood ratio; LR–, negative likelihood ratio; OESIL, Osservatorio Epidemiologico sulla Sincope nel Lazio; SBP, systolic blood pressure.