Syncope
Research
Program

CSRS Tool

Canadian Syncope Risk Score Calculator

Instructions

When to use?

Inclusion criteria:

Patient > 18 years old presenting ≤ 24 hours of syncope

Exclusion criteria:

Prolonged LOC (i.e. > 5 mins)
GCS < 15 in patients without dementia
Change in the mental status from baseline in those with dementia
Obvious witnessed seizure
Head trauma preceding LOC
Significant trauma requiring hospital admission
Unable to provide details due to intoxication with alcohol or other substance
Language barrier

What does it predict?

Predicts risk of 30-day serious adverse events associated with syncope, defined as any of the following: death, arrhythmia, non-arrhythmic cardiac causes, or non-cardiac causes. (see article).

Clinical evaluation

Predisposition to vasovagal symptoms

Triggered by warm crowded places, fear, pain, etc.

Heart disease history

CAD, CHF, valvular HD, cardiomyopathy, etc.

Systolic blood pressure in the emergency department <90 or >180 mmHg

Includes blood pressure values from triage until disposition from the emergency department

Investigations

Elevated troponin

>99th percentile of normal population

If troponin testing was not performed or results are unavailable, please select 'No'.

Abnormal QRS axis

< -30° or > 100°

QRS duration >130 milliseconds

Corrected QT interval >480 milliseconds

Diagnosis in emergency department

Vasovagal / Reflex / Neurally mediated syncope

Based on evaluation and clinical impression in ED. Features include: vasovagal predisposition; prodrome of diaphoresis, warmth, nausea/vomiting, pallor; hypotension or bradycardia; often followed by fatigue; may be situational (e.g. micturition, cough).

Cardiac syncope

Based on evaluation and clinical impression in ED. Features include: exertional syncope; preceded by palpitations; sudden with no prodrome; injury from fall; family history of sudden death; history of heart disease; ECG suggesting structural or arrhythmic issues.

Unexplained syncope

Based on ED evaluation and impression, patient does not meet criteria for vasovagal or cardiac syncope.