Potential Impact of Using Canadian Syncope Risk Score on Emergency Department Hospitalizations for Syncope

Syncope is a common emergency department (ED) presentation and frequently results in low-yield hospitalizations. The Canadian Syncope Risk Score (CSRS) is a validated risk stratification score that identifies 30-day risk of serious adverse events for patients presenting with syncope. In this retrospective, cross-sectional study we aimed to evaluate syncope admissions with the CSRS to determine potentially unnecessary hospitalizations.

We identified patient visits for syncope at 11 EDs from February 2019-January 2020. We excluded patients with additional serious diagnoses that would have independently required admission and those who were discharged. We then randomly sampled the remaining charts until finding 200 that met study inclusion criteria on full chart review. We retrospectively calculated CSRS via manual chart review and identified the proportion of patients with low-risk CSRS. We compared demographic characteristics between those with low- vs medium- and high-risk CSRS.

We identified 5,718 adult patients hospitalized for syncope. Of these patient visits 3,999 were initially excluded, 336 were sampled, and 200 included for analysis. Of these, 39% (77/200, 95% CI 32-46%]) were low risk (CSRS < 1). Patients with low-risk CSRSs were younger (61.2 years vs 70.6 years of age; absolute difference [AD] 9.4 years; 95% CI 4.8-13.9), less likely to have heart disease (1.3% vs 61.8%; AD 60.5%, 95% CI -69.4% to -51.5%), and more likely to have substance use disorder (14.3% vs 4.9%; AD 9.4%, 95% CI 0.7-18.1%).

In this sample of patients hospitalized for syncope, 39% had low-risk Canadian Syncope Risk Score. Had the CSRS been used, these patients could have been safely discharged, as their estimated 30-day serious adverse event rate was < 1%. Wider adoption of the CSRS could potentially reduce unnecessary hospitalizations for patients with syncope.