• Tobias Zimmermann, Jeanne du Fay de Lavallaz, Thomas Nestelberger, Danielle M Gualandro, Pedro Lopez-Ayala, Patrick Badertscher, Velina Widmer, Samyut Shrestha, Ivo Strebel, Noemi Glarner, Matthias Diebold, Òscar Miró, Michael Christ, Louise Cullen, Martin Than, F Javier Martin-Sanchez, Salvatore Di Somma, W Frank Peacock, Dagmar I Keller, Murat Bilici, Juan Pablo Costabel, Michael Kühne, Tobias Breidthardt, Venkatesh Thiruganasambandamoorthy, Christian Mueller, BASEL IX Investigators†, Maria Belkin, Kathrin Leu, Jens Lohrmann, Jasper Boeddinghaus, Raphael Twerenbold, Luca Koechlin, Joan E Walter, Melissa Amrein, Desiree Wussler, Michael Freese, Christian Puelacher, Damian Kawecki, Beata Morawiec, Emilio Salgado, Gemma Martinez-Nadal, InostrozaCarolina Isabel FuenzalidaCIF, José Bustamante Mandrión, Imke Poepping, Katharina Rentsch, Arnold von Eckardstein, Andreas Buser, Jaimi Greenslade, Tobias Reichlin, and Franz Bürgler.
• Cardiovascular Research Institute Basel (CRIB), Department of Cardiology, and Department of Intensive Care Medicine, University Hospital Basel, University of Basel, Basel, Switzerland, and GREAT Network, Rome, Italy (T.Z.).
• Ann. Intern. Med. 2022 Jun 1; 175 (6): 783794783-794.

BackgroundThe Canadian Syncope Risk Score (CSRS) was developed to predict 30-day serious outcomes not evident during emergency department (ED) evaluation.ObjectiveTo externally validate the CSRS and compare it with another validated score, the Osservatorio Epidemiologico della Sincope nel Lazio (OESIL) score.DesignProspective cohort study.SettingLarge, international, multicenter study recruiting patients in EDs in 8 countries on 3 continents.ParticipantsPatients with syncope aged 40 years or older presenting to the ED within 12 hours of syncope.MeasurementsComposite outcome of serious clinical plus procedural events (primary outcome) and the primary composite outcome excluding procedural interventions (secondary outcome).ResultsAmong 2283 patients with a mean age of 68 years, the primary composite outcome occurred in 7.2%, and the composite outcome excluding procedural interventions occurred in 3.1% at 30 days. Prognostic performance of the CSRS was good for both 30-day composite outcomes and better compared with the OESIL score (area under the receiver-operating characteristic curve [AUC], 0.85 [95% CI, 0.83 to 0.88] vs. 0.74 [CI, 0.71 to 0.78] and 0.80 [CI, 0.75 to 0.84] vs. 0.69 [CI, 0.64 to 0.75], respectively). Safety of triage, as measured by the frequency of the primary composite outcome in the low-risk group, was higher using the CSRS (19 of 1388 [0.6%]) versus the OESIL score (17 of 1104 [1.5%]). A simplified model including only the clinician classification of syncope (cardiac syncope, vasovagal syncope, or other) variable at ED discharge-a component of the CSRS-achieved similar discrimination as the CSRS (AUC, 0.83 [CI, 0.80 to 0.87] for the primary composite outcome).LimitationUnable to disentangle the influence of other CSRS components on clinician classification of syncope at ED discharge.ConclusionThis international external validation of the CSRS showed good performance in identifying patients at low risk for serious outcomes outside of Canada and superior performance compared with the OESIL score. However, clinician classification of syncope at ED discharge seems to explain much of the performance of the CSRS in this study. The clinical utility of the CSRS remains uncertain.Primary Funding SourceSwiss National Science Foundation & Swiss Heart Foundation.

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