Canadian Syncope Risk Score: Validated Internationally

Educational Objectives

Summary

Canadian Syncope Risk Score Now Is Validated Internationally

The Canadian Syncope Risk Score (CSRS; https://www.mdcalc.com/canadian-syncope-risk-score) — the largest prospectively validated risk stratification tool for patients presenting to emergency departments (EDs) with syncope — initially was derived and validated in Canada. Now, for a study on the website of the Annals of Internal Medicine (https://doi.org/10.7326/M21-2313), investigators formed an international prospective cohort of 2283 patients (from the U.S., Australia, New Zealand, and 5 European countries) who presented to EDs with syncope, to compare the CSRS to a previously validated European syncope risk stratification tool (OESIL score; https://www.mdcalc.com/oesil-score-syncope).

The CSRS triaged 60% of patients as low or very low risk; the OESIL score triaged 48% as low risk. Low- and very low–risk patients categorized via the CSRS had significantly lower 30-day serious adverse event rates than did low-risk patients categorized via the OESIL score (1.1% vs 2.7%); this difference was significant even after excluding procedure intervention (e.g., pacemaker placement) outcomes (0.6% vs 1.5%). Clinician classification of syncope (i.e., cardiac, vasovagal, or other) at ED discharge — a component of the CSRS — had similar discrimination as did the full CSRS.

With wide variation in hospital admission rates for syncope — as low as 12% in parts of Canada and as high as 80% in some U.S. centers — implementation of the CSRS could reduce such admissions for low-risk patients. Interestingly, clinician classification (i.e., “gestalt”) functioned as well as the full CSRS in this study, in contrast with the initial Canadian studies; the finding suggests that, in some EDs, a syncope workup is so extensive (and arguably excessive) that the cause usually is clear by the time the patient leaves the ED. This international study validates CSRS performance to identify patients at low risk for serious outcomes who are potential candidates for ED discharge.

Daniel D. Dressler, MD, MSc, MHM, FACP

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Acknowledgements

CME/CE INFO

Accreditation:

The Audio- Digest Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Audio- Digest Foundation designates this enduring material for a maximum of 0.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Lecture ID:

JW331212

Expiration:

This CME course qualifies for AMA PRA Category 1 Credits™ for 3 years from the date of publication.

Instructions:

To earn CME/CE credit for this course, you must complete all the following components in the order recommended: (1) Review introductory course content, including Educational Objectives and Faculty/Planner Disclosures; (2) Listen to the audio program and review accompanying learning materials; (3) Complete posttest (only after completing Step 2) and earn a passing score of at least 80%. Taking the course Pretest and completing the Evaluation Survey are strongly recommended (but not mandatory) components of completing this CME/CE course.

Estimated time to complete this CME/CE course:

Approximately 2x the length of the recorded lecture to account for time spent studying accompanying learning materials and completing tests.

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