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A modified Canadian Syncope Risk Score for emergency department use.

Jacopo Davide Giamello1, Salvatore D'Agnano2, Remo Melchio3

  • 1Department of Emergency Medicine, Santa Croce e Carle Hospital, via Michele Coppino 26, 12100, Cuneo, Italy. jacopo.giamello@gmail.com.

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|February 10, 2026
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Summary
This summary is machine-generated.

A modified Canadian Syncope Risk Score (CSRS-ED) accurately predicts serious outcomes in emergency department (ED) syncope patients. This score aids in early risk stratification and safe discharge decisions without needing an ED diagnosis.

Keywords:
Emergency departmentCanadian Syncope Risk ScoreRisk stratification

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Area of Science:

  • Emergency Medicine
  • Cardiology
  • Clinical Risk Stratification

Background:

  • Syncope is a common emergency department presentation with variable risks.
  • Accurate early risk stratification is crucial but challenging.
  • Existing tools like the Canadian Syncope Risk Score (CSRS) may lack real-time applicability due to requiring an ED diagnosis.

Purpose of the Study:

  • To evaluate a modified CSRS (CSRS-ED) that excludes the ED diagnosis variable.
  • To assess the CSRS-ED's accuracy in predicting 30-day serious outcomes in syncope patients.
  • To compare the CSRS-ED's performance against other established syncope risk scores.

Main Methods:

  • Retrospective, single-center study of 935 syncope patients.
  • Assessed 30-day composite endpoint of serious conditions and all-cause mortality.
  • Evaluated CSRS-ED performance using discrimination, calibration, and diagnostic accuracy metrics.

Main Results:

  • The CSRS-ED demonstrated excellent discrimination (AUROC 0.87).
  • At a threshold of ≥0, sensitivity was 0.97, with a negative predictive value of 0.99.
  • The score showed good calibration and outperformed other scores like SFSR, EGSYS, and OESIL.

Conclusions:

  • The CSRS-ED is a practical and accurate tool for early risk stratification of syncope patients.
  • It can be used for safe discharge decisions without requiring an adjudicated ED diagnosis.
  • This modified score enhances real-time applicability in the emergency department setting.