StudyPopulationPredictor variablesOutcome measuredScore resultsValidationComments

  • Boston Syncope Rule, 2007 (short-term risk)

  • Derivation: a priori

  • Validation: 362 ED patients with syncope

  • Signs of volume depletion

  • Persistent abnormal vital signs in the ED

  • Signs and symptoms of acute coronary syndrome

  • Signs of conduction disease

  • Worrisome cardiac history

  • Family history of sudden death

  • Primary central nervous system event

  • Valvular heart disease (from history or physical examination)

  • Critical intervention or adverse outcome at 30 days

  • Consider admission for one or more variables

  • Internal: 97% sensitivity, 62% specificity

  • External: none

  • 25 variables in eight categories make it less practical

  • Canadian Syncope Risk Rule, 2016 (short-term risk)

  • Derivation: 4,030 ED patients with syncope

  • Validation: pending

  • Predisposition to vasovagal syncope (prodrome/trigger)

  • History of heart disease

  • Systolic blood pressure < 90 mm Hg or > 180 mm Hg

  • Elevated troponin level

  • Abnormal QRS axis (< 30 or > 110 degrees)

  • QRS duration > 130 milliseconds

  • Corrected QT interval > 480 milliseconds

  • ED diagnosis of vasovagal syncope

  • ED diagnosis of cardiac syncope

  • Serious event at 30 days: death, arrhythmia, MI, PE, aortic dissection, CVA, or procedural intervention for syncope

  • Estimated risk of serious adverse event at 30 days

  • Pending

  • Largest prospective study, outcomes consistent with guidelines, clarifies abnormal ECG findings, pending validation to support use of rule

  • EGSYS score, 2008 (short- and long-term risk)

  • Derivation: 260 ED patients with syncope

  • Validation: 258 ED patients with syncope

  • Palpitations preceding syncope (4 points)

  • Abnormal ECG findings* or history of heart disease (3 points)

  • Syncope during effort (3 points) or when supine (2 points)

  • Autonomic prodromes (−1 point)

  • Precipitating and/or predisposing factors (−1 point)

  • Probability of cardiogenic syncope at two years

  • Consider admission for score of 3 or higher

  • Internal: 92% sensitivity, 69% specificity

  • External: 56% sensitivity, 84% specificity

  • Mortality at two years was 2% in patients with scores < 3 and 21% for scores = 3

  • OESIL risk score, 2003 (long-term risk)

  • Derivation: 270 ED patients with syncope

  • Validation: 328 ED patients with syncope

  • Abnormal ECG findings*

  • Absence of prodromal syndrome

  • Age > 65 years

  • History of cardiac disease

  • Mortality at one year

  • Consider admission for one or more variables

  • Internal: 100% sensitivity, 22% specificity

  • External: 95% sensitivity, 31% specificity

  • Positive variables:

  • 0: 0% mortality

  • 1: 0.6% mortality

  • 2: 14% mortality

  • 3: 29% mortality

  • 4: 53% mortality

  • ROSE study, 2010 (short-term risk)

  • Derivation: 550 ED patients with syncope

  • Validation: 550 ED patients with syncope

  • Anemia (hemoglobin = 9 g per dL [90 g per L])

  • Bradycardia (< 50 beats per minute)

  • Brain natriuretic peptide = 300 pg per mL (300 ng per L)

  • Chest pain with syncope

  • ECG showing Q waves (except in lead III)

  • Oxygen saturation < 94% on room air

  • Rectal examination showing occult blood (if gastrointestinal bleeding suspected)

  • Serious events at one month: death, acute MI, PE, CVA, arrhythmias, hemorrhage requiring transfusion of two or more units, subarachnoid hemorrhage, acute procedure, need for pacemaker in first month

  • Consider admission for one or more variables

  • Internal: 87% sensitivity, 66% specificity

  • One-year outcomes: 72% sensitivity, 71% specificity

  • External: none

  • Not useful for predicting outcomes at one year; first study to use a biomarker in risk stratification

  • San Francisco Syncope Rule, 2004 (short-term risk)

  • Derivation: 684 ED patients with syncope or near syncope

  • Validation: 791 ED patients with syncope or near syncope

  • Abnormal ECG findings*

  • Congestive heart failure

  • Hematocrit < 30%

  • Shortness of breath

  • Systolic blood pressure < 90 mm Hg

  • Serious events at seven days: acute MI, PE, CVA, arrhythmias, subarachnoid hemorrhage, return ED visit, readmission

  • Consider admission for one or more variables

  • Internal: 98% sensitivity, 56% specificity

  • External: 87% sensitivity, 52% specificity

  • First tool for short-term events (seven days); inconsistencies in validation scores, but the most studied decision tool