Canadian Syncope Risk Score Demonstrates International External Validation

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1. The Canadian syncope risk score was superior to the Osservatorio Epidemiologico della Sincope nel Lazio (OESIL) score in identifying patients at low risk for serious outcomes.

2. The clinical utility of the Canadian Syncope Risk Score (CSRS) remains uncertain given the influence of clinician classification of syncope at discharge from the ED affecting the performance of the SCRS.

Evidence rating level: 3 (medium)

Summary of the study: The Canadian Syncope Risk Score (CSRS) was developed to predict a composite of serious 30-day clinical and procedural events not evident at ED assessment. Initial national validation showed high prognostic accuracy, and the CSRS was therefore introduced as a decision tool after completing the assessment of emergency departments, with the primary aim of helping to identify patients at low risk of outcome. serious at 30 days in whom hospitalization, which is associated with a weak diagnosis. yield and higher costs, can be avoided. However, there is a knowledge gap regarding the performance and clinical usefulness of SCRS in syncoped patients presenting to emergency departments in countries outside of Canada. This study demonstrated that, based on international external validation, the CSRS performed well in identifying patients at low risk of severe progression and was superior to the OSEIL score, another validated score. This study was limited by its inability to disentangle the influence of other components of the CSRS on the clinician’s classification of syncope at discharge from the emergency department. Nevertheless, the results of these studies are significant, as they demonstrate the international validation of CSRS, although further discernment of the clinical utility of CSRS is needed.

Click to read the study in AIM

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In depth [prospective cohort study]: This prospective cohort study examined 2283 emergency department patients in 8 countries on 3 continents, including the United States, Switzerland, Spain, Germany, Italy, Poland, New Zealand and Australia. Patients aged 40 or older who presented to the emergency department with syncope within the past 12 hours were eligible for the study. Patients who had a non-syncopal loss of consciousness such as a fall or stroke, or who had an adverse event or indication for procedural intervention identified during the ED assessment were excluded from the study. study. The primary outcome measured was 2 composites summarizing serious outcomes at 30 days not evident in the emergency department. A composite measure of serious clinical and procedural outcomes, including death, life-threatening arrhythmia, myocardial infarction, and other serious outcomes, was included to address the possibility of a causal chain between hospitalization and procedural intervention for the treatment of syncope. Results from the primary analysis were evaluated via Cox regression models and Kaplan-Meier curves to examine the impact of composite results over time. Based on the primary analysis, the prognostic performance of CSRS was good for the composite outcomes at 30 days and better compared to the OESIL score (area under the receiver operating characteristic curve [AUC], 0.85; 95% confidence interval {CI}, 0.83 to 0.88) versus 0.69 (95% CI, 0.64 to 0.75). Additionally, triage safety was higher using the CSFS score compared to the OESIL score (0.6% versus 1.5%). However, a simplified model including only the clinician classification of syncope (a component of the CSRS) achieved similar discrimination as the CSRS (AUC, 0.83; 95% CI, 0.8 to 0.87) for the primary composite result. Overall, this study demonstrates that the CSRS performed well on international validation for identifying patients at low risk for serious outcomes outside of Canada, but clinician classification of syncope upon discharge from the Urgency appears to explain much of the performance of CSRS in this study, and therefore, the clinical utility of CSRS is still uncertain.

Picture: PD

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