Table 1 Risk stratification tools

Cardiac ischemia in syncope

Georgeson et al. (1992)

1. Ischemic abnormalities on the ECG obtained in the ED

2. Arm or shoulder pain on presentation

3. Rales on physical examination in the ED

4. Prior history of exercise-induced angina or myocardial infarction

Not described

Not described

Risk stratification in syncope

Martin et al. (1997)

1. Abnormal ECG

2. History of ventricular arrhythmia

3. History of congestive heart failure

4. Age > 45 years

5. Nonwhite race

6. No prior history of syncope

One point for each variable

Not described

Risk score to predict arrhythmias in unexplained syncope

Sarasin et al. (2003)

1. Abnormal ECG

2. Age ≥ 65 years

3. History of congestive heart failure

One point for each variable

Score 0: very low risk

OESIL

Colivicchi et al. (2003)

1. Age > 65 years

2. Cardiovascular disease in clinical history

3. Syncope without prodrome

4. Abnormal ECG

One point for each variable

Score 0–1: low risk --> outpatient evaluation and follow-up

Score 2–4: high risk --> admission to the hospital

SFSR

Quinn et al. (2004)

C: Congestive heart failure

H: Hematocrit < 30%

E: Abnormal ECG

S: Shortness of breath

S: Systolic blood pressure < 90 mmHg

One point for each variable

If ≥ 1 variable is present: high risk of a serious outcome

Boston Syncope Criteria

Grossman et al. (2007)

1. Signs and symptoms of Acute Coronary Syndrome

2. Signs of conduction disease

3. Worrisome cardiac history

4. Valvular heart disease by history or physical examination

5. Family history of sudden death

6. Persistent abnormal vital signs in the ED

7. Volume depletion

8. Primary central nervous system event

One point for each variable

If any of the variables are present the patient should be admitted

EGSYS

Del Rosso et al. (2008)

1. Abnormal ECG and/or heart disease

2. Palpitations before syncope

3. Syncope during effort

4. Syncope in supine position

5. Absence of autonomic prodromes

6. Absence of predisposing and/or precipitating factors

Element 1: +3

Element 2: +4

Element 3: +3

Element 4: +2

Element 5: -1

Element 6: -1

Patients with a score ≥ 3 should be admitted

Syncope Risk Score

Sun et al. (2009)

1. Age ≥ 90 years

2. Male gender

3. History of an arrhythmia

4. Triage systolic blood pressure > 160 mmHG

5. Abnormal ECG

6. Abnormal Troponin I level

7. Complaint of near-syncope

Element 1–6: +1

Element 7: -1

Score − 1 − 0: low risk

Score 1–2: intermediate risk

Score 3–6: high risk

ROSE

Reed et al. (2010)

B: BNP level > 300pv/ml or Bradycardia < 50/min

(in ED or prehospital)

R: Rectal examination showing fecal occult blood

A: Anemia, HB < 90 g/L

C: Chest pain associated with syncope

E: ECG showing Q wave (not in lead III)

S: Saturation < 94% - room air

One point for each variable

If ≥ 1 variable is present: high risk of a serious outcome

Consider admission if ≥ 1 variable is present

Anatolian Syncope Rule

Kayayurt et al. (2012)

D: Dyspnoea

O: Ortostatism

P: Precipitating cause for syncope

A: Age > 58 years

C: Congestive heart failure history

E: ECG abnormality

Element D - C: +1

Element E: +2

A score > 1: high risk syncope

A score > 2: high risk mortality

Ottawa Electrocardiographic Criteria

Thiruganasambandamoorthy et al. (2012)

Based on ECG of the patient

1. Blocks:

a. Second-degree Mobitz type 2 or third-degree AV block

b. Bundle branch block + first-degree AV block

c. Right bundle branch + left anterior or posterior fascicular block

2. New ischemic changes

3. Nonsinus rhythm

4. Left axis deviation

5. ED cardiac monitor abnormalities

One point for each variable

If ≥ 1 variable is present: high risk of a serious outcome

CHADS2 score

Ruwald et al. (2013)

C: Chronic heart failure

H: Hypertension

A: Age ≥ 75 years

D: Diabetes

S: Prior transient ischemic attack or stroke

Element C - D: +1

Element S: +2

Not described

Syncope Risk Scale

Thiruganasambandamoorthy et al. (2014)

1. Age ≥ 75 years

2. Shortness of breath

3. Lowest ED systolic BP < 80 mmHG

4. The presence of the Ottawa Electrocariographic Criteria

5. BUN > 15 mmol/L

Element 1: +1

Element 2: +2

Element 3: +2

Element 4: +2

Element 5: +3

Score 0: low risk

Score 1: moderate risk

Score ≥ 2: high risk

CSRS

Thiruganasambandamoorthy et al. (2016)

1. Predisposition to vasovagal syncope

2. Heart disease

3. Any systolic pressure in the ED < 90 or > 180 mmHG

4. Troponin level > 99th percentile for the normal population

5. Abnormal QRS axis (<-30° of > 100°)

6. QRS duration > 130 ms

7. QTc interval > 480 ms

8. ED diagnosis of cardiac syncope

9. ED diagnosis of vasovagal syncope

Element 1: -1

Element 2: +1

Element 3: +2

Element 4: +2

Element 5: +1

Element 6: +1

Element 7: +2

Element 8: +2

Element 9: -2

Score − 3 - -2: very low risk

Score − 1 − 0: low risk

Score 1–3: medium risk

Score 4–5: high risk

Score 6–11: very high risk

IC-FUC score

Gomes et al. (2016)

1. Previous history of syncope

2. Known heart disease

3. Abnormal ECG

Element 1: +2

Element 2: +4

Element 3: +3

Not described

Canadian Syncope Arrhythmia Risk Score

Thiruganasambandamoorthy et al. (2017)

1. Vasovagal predisposition

2. History of heart disease

3. Any ED systolic BP < 90 or > 180mmHG

4. Troponin elevated (> 99%ile normal population)

5. QRS duration > 130 ms

6. Corrected QT interval > 480 ms

7. ED diagnosis of vasovagal syncope

8. ED diagnosis of cardiac syncope

Element 1: -1

Element 2: +1

Element 3: +1

Element 4: +1

Element 5: +2

Element 6: +1

Element 7: -1

Element 8: +2

Score − 2 − 0: very low risk

Score 1: low risk

Score 2–3: medium risk

Score 4–5: high risk

Score 6–8: very high risk

NEWS2-L

Martín-Rodriquez et al. (2020)

1. NEWS2

- Heart rate (0–3 points)

- Breathing rate (0–3 points)

- Temperature (0–3 points)

- Systolic blood pressure (0–3 points)

- Oxygen saturation (0–3 points)

- Air oxygen (0–2 points)

- AVPU (0–3 points)

2. pLA

Element 1: numerical value of all determinants together

Element 2: numerical value of the test

A score ≥ 6.9: high risk syncope

FAINT score

Probst et al. (2020)

F: History of heart Failure

A: History of cardiac Arrhythmia

I: Abnormal Initial ECG

N: Elevated NT-pro-BNP level

T: Elevated hs-cTnT level

Element N: +2

Other elements: +1

Score > 0: high risk syncope

ALERT-CS

Zimmerman et al. (2021)

1. Rhythm

2. Heart rate

3. Corrected QT-interval

4. ST-segment depression

5. Atrioventricular-block

6. Bundle-branch-block

7. Ventricular extrasystole/non-sustained

ventricular tachycardia

Computational calculation of probability of cardiac cause of syncope

Rule-in high risk: 37.5% Rule-out: <5.5%