What are the scoring tools for diagnosing syncope?

From the Guidelines

The scoring tools for diagnosing syncope include the Martin score, Sarasin score, OESIL score, SFSR score, Boston Syncope Rule, Del Rosso score, STePS score, Syncope Risk Score, and ROSE score.

Scoring Tools

• These tools use various predictors such as abnormal ECG, age, cardiac history, and symptoms to determine the risk of serious events or cardiac etiology in patients with syncope 1.
• The Boston Syncope Rule and ROSE score are examples of scoring tools that have been validated to predict serious events in patients with syncope 1.
• The Syncope Risk Score is another tool that uses predictors such as abnormal ECG, age, and cardiac history to determine the risk of serious events in patients with syncope 1.

Key Predictors

• Abnormal ECG is a common predictor used in many of the scoring tools, and is defined as any rhythm other than normal sinus rhythm, conduction delays, presence of Q waves, ST abnormalities, or prolonged QT interval 1.
• Age is also a significant predictor, with older patients being at higher risk of serious events or cardiac etiology 1.
• Cardiac history and symptoms such as palpitations, exertional syncope, and supine syncope are also important predictors used in the scoring tools 1.

Clinical Application

• The scoring tools can be used in clinical practice to risk-stratify patients with syncope and determine the need for further evaluation or hospital admission 1.
• The ACC/AHA/Heart Rhythm Society 2017 guideline recommends the use of scoring tools such as the Boston Syncope Rule and ROSE score to guide hospital admission for syncope 1.

From the Research

Scoring Tools for Diagnosing Syncope

The following scoring tools have been identified for diagnosing syncope:

• Osservatorio Epidemiologico sulla Sincope del Lazio (OESIL) score 2
• San Francisco Syncope Rule (SFSR) score 2, 3, 4
• Evaluation of Guidelines in Syncope Study (EGSYS) score 2
• Risk Stratification of Syncope in the Emergency Department (ROSE) score 3
• FAINT score 3
• Canadian Syncope Risk Score (CSRS) score 3, 4
• Boston Syncope Criteria (BSC) score 3
• Calgary Syncope Seizures Score 5
• Calgary Syncope Score for normal hearts 5
• Calgary Syncope Score for Structural Heart Disease 5
• CHADS2 score 6

Comparison of Scoring Tools

Studies have compared the effectiveness of these scoring tools in predicting the prognosis of patients presenting to the emergency department with syncope:

• A study found that the CSRS score had the highest predictive power of mortality 4
• Another study found that the CHADS2 score performed comparably to more complicated syncope-specific risk scores in the prediction of death and MACE in ED syncope patients 6
• A study also found that the SFSR, FAINT, CSRS, and BSC tools could be useful for physicians in screening older patients with syncope for the risk of short-term adverse events 3

Limitations of Scoring Tools

Despite the availability of these scoring tools, studies have noted that:

• Current prediction tools did not show better sensitivity, specificity, or prognostic yield compared with clinical judgment in predicting short-term serious outcome after syncope 2
• The scoring tools have not been largely adopted, possibly due to their lack of sensitivity and specificity 2