From the Guidelines
The primary scoring tools for diagnosing syncope in the Emergency Department (ED) include the Boston Syncope Rule, Sarasin, OESIL, SFSR, STePS, Syncope Risk Score, and ROSE 1.
Key Scoring Tools
- Boston Syncope Rule: Predicts 30-day serious events, including death, major therapeutic procedure, MI, arrhythmia, pulmonary embolism, stroke, sepsis, hemorrhage, or life-threatening sequelae of syncope 1.
- Sarasin: Predicts inpatient arrhythmia, using predictors such as abnormal ECG, age >65 years, and heart failure 1.
- OESIL: Predicts 1-year death, using predictors such as abnormal ECG, age >65 years, no prodrome, and cardiac history 1.
- SFSR: Predicts 7-day serious events, including death, MI, arrhythmia, pulmonary embolism, stroke, hemorrhage, or readmission, using predictors such as abnormal ECG, dyspnea, hematocrit, systolic BP <90 mmHg, and heart failure 1.
- STePS: Predicts 10-day serious events, including death, major therapeutic procedure, or readmission, using predictors such as abnormal ECG, trauma, no prodrome, and male sex 1.
- Syncope Risk Score: Predicts 30-day serious events, including death, major therapeutic procedure, MI, arrhythmia, pulmonary embolism, stroke, sepsis, hemorrhage, or life-threatening sequelae of syncope, using predictors such as abnormal ECG, age >90 years, male sex, positive troponin, history of arrhythmia, systolic BP >160 mmHg, and near-syncope 1.
- ROSE: Predicts 30-day serious events, including death, major therapeutic procedure, MI, arrhythmia, pulmonary embolism, stroke, sepsis, hemorrhage, or life-threatening sequelae of syncope, using predictors such as abnormal ECG, B-natriuretic peptide, hemoglobin, O2Sat, and fecal occult blood 1.
Use in Clinical Practice
These scoring tools can be used to risk-stratify patients with syncope in the ED, identifying those with high-risk conditions who require admission and those with low-risk conditions who can be discharged and referred for further evaluation 1. The negative predictive value (NPV) of these scoring tools ranges from 93% to 100%, indicating their usefulness in identifying patients at low risk of serious events 1. However, it is essential to note that these scoring tools should be used in conjunction with clinical judgment and individual patient assessment to ensure accurate diagnosis and management of syncope in the ED.
From the Research
Scoring Tools for Diagnosing Syncope in the Emergency Department (ED)
The following scoring tools have been identified for diagnosing syncope in the ED:
- Canadian Syncope Risk Score (CSRS) 2, 3
- San Francisco Syncope Rule (SFSR) 2
- Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score 4, 2
- CHADS2 score 4
- FAINT score 5
Key Elements of Scoring Tools
The key elements of these scoring tools include:
- History taking
- Physical examination
- Electrocardiogram (ECG)
- Additional examinations (e.g. laboratory tests)
- Other variables (e.g. medical history, age)
Validation of Scoring Tools
The validation of these scoring tools has been studied in several studies:
- The CSRS has been validated in multiple studies, with a positive likelihood ratio (LR+) of 1.15-2.58 and a negative likelihood ratio (LR-) of 0.05-0.50 2, 3
- The SFSR has been validated in 12 studies, with a LR+ of 1.15-4.70 and a LR- of 0.03-0.64 2
- The OESIL risk score has been validated in five studies, with a LR+ of 1.16-3.32 and a LR- of 0.14-0.46 4, 2
- The CHADS2 score has been shown to perform well in predicting death and major cardiovascular events in ED syncope patients 4
- The FAINT score has been derived and validated in a prospective, observational study, with a sensitivity of 96.7% and a specificity of 22.2% for predicting 30-day serious cardiac outcomes 5