External validation of the Canadian Syncope Risk Score for patients presenting with undifferentiated syncope to the emergency department

Abstract

Objective To validate the accuracy and safety of the Canadian Syncope Risk Score (CSRS) for patients presenting with syncope. Methods Single centre prospective observational study in Brisbane, Australia. Adults presenting to the ED with syncope within the last 24 h were recruited after applying exclusion criteria. Study was conducted over 1 year, from March 2018 to March 2019. Thirty‐day serious adverse events (SAE) were reported based on the original derivation study and standardised outcome reporting for syncope. Individual patient CSRS was calculated and correlated with 30‐day SAE and disposition status from ED. Results Two hundred and eighty‐three patients were recruited to the study. Average age was 55.6 years (SD 22.7 years), 37.1% being male with a 39.9% admission rate. Thirty‐day SAE occurred in seven patients (2.5%) and no recorded deaths. The CSRS performed with a sensitivity of 71.4% (95% confidence interval [CI] 30.3–94.9%), specificity 72.8% (95% CI 67.1–77.9%) for a threshold score of 1 or higher. Conclusion Syncope patients in our study were predominantly very low to low risk (72%). The prevalence of 30‐day SAE was low, majority occurring following hospital discharge. Sensitivity estimates for CSRS was lower than the derivation study but lacked robustness with wide CIs because of a small sample size and number of events observed. However, the CSRS did not miss any clinically relevant outcomes in low risk patients making it potentially useful in aiding their disposition. Larger validation studies in Australia are encouraged to further test the diagnostic accuracy of the CSRS.

Assessment of Canadian Syncope Risk Score in the prediction of outcomes of patients with syncope at the Emergency Department of Suez Canal University

“…In other hand, there were 141 (49.8%) very-low-risk, 62 (21.9%) low-risk, 61 (21.6%) medium-risk, 12 (4.2%) high-risk and 7 (2.5%) very-high-risk patients identified in Chan et al, 2020 study. [ 8 ]…”

“…The CSRS performed with the same sensitivity for a threshold score of 1 or higher but with higher specificity of 72.8%. [ 8 ]…”

A Rational Evaluation of the Syncope Patient: Optimizing the Emergency Department Visit

“…The model had a 97.8% sensitivity and 44.3% specificity at a score of −1 or higher. An Australian single center validation study in 283 patients, however, demonstrated a lower sensitivity (71.4%) of a CSRS −1 [ 54 ]; similar sensitivity was maintained at a CSRS threshold of 1, with improved specificity (72.8%), and maintained a negative predictive value of 99%.…”

Prognostic accuracy of syncope clinical prediction rules in older adults in the emergency department

“…Notable examples include the San Francisco Syncope Rule (SFSR) 4 and the Canadian Syncope Risk Score (CSRS) 5 . These rules have displayed mixed results in external validation studies 6–9 . None of these rules have been widely adopted in clinical practice.…”

“… 5 These rules have displayed mixed results in external validation studies. 6 , 7 , 8 , 9 None of these rules have been widely adopted in clinical practice. Furthermore, guidelines for the management of syncope emphasize that existing risk scores should not be used alone for risk stratification because they have not performed better than unstructured clinical judgment.…”