From the Guidelines
Risk stratification scores for classification of 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. These scores are used to predict the risk of adverse outcomes, such as death, arrhythmia, or cardiac etiology, in patients with syncope.
Key Components of Risk Stratification Scores
- Abnormal ECG: defined variably in these studies, but generally includes any rhythm other than normal sinus rhythm, conduction delays, presence of Q waves, ST abnormalities, or prolonged QT interval 1
- Age: older age (>45 years, >65 years, or >90 years) is a predictor of adverse outcomes in several scores 1
- History of heart failure: a predictor of adverse outcomes in several scores 1
- History of ventricular arrhythmias: a predictor of adverse outcomes in several scores 1
Examples of Risk Stratification Scores
- Martin score: includes abnormal ECG, age >45 years, history of ventricular arrhythmias, and history of heart failure 1
- Boston Syncope Rule: includes symptoms of acute coronary syndrome, worrisome cardiac history, family history of sudden cardiac death, and signs of conduction disease 1
- Syncope Risk Score: includes abnormal ECG, age >90 years, male sex, positive troponin, history of arrhythmia, and systolic BP >160 mmHg 1 These scores can help clinicians identify patients at high risk of adverse outcomes and guide management decisions, such as hospital admission or further evaluation 1.
From the Research
Risk Stratification Scores for Syncope
The following risk stratification scores are used for the classification of syncope:
- San Francisco Syncope Rule (SFSR) 2
- Canadian Syncope Risk Score (CSRS) 2
- Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL) risk score 2
- FAINT score, which includes history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T 3
Key Elements of Risk Stratification Tools
The key elements of risk stratification tools for syncope patients include:
- History taking
- Physical examination
- Electrocardiogram
- Additional examinations
- Other variables, such as presence of concomitant conditions, especially cardiovascular disease 4, 5
Challenges in Initial Syncope Management
The initial management of syncope is challenging due to the need for rapid risk stratification and the limited time and resources available in emergency medical services and emergency departments 4, 5
- The European Society of Cardiology syncope guidelines recommend an initial syncope workup based on detailed patient's history, physical examination, supine and standing blood pressure, resting ECG, and laboratory tests, including cardiac biomarkers, where appropriate 4
- The guidelines also recommend subsequent risk stratification based on screening of features to identify high-, intermediate-, and low-risk groups 4
Accuracy of Risk Stratification Tools
The accuracy of risk stratification tools for syncope patients varies, with some tools having higher sensitivity and specificity than others 3, 2