A modified Canadian Syncope Risk Score for emergency department use

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.