Canadian Syncope Risk Score

By Dr. Costa / July 4, 2026

Canadian Syncope Risk Score

Predicts the risk of serious adverse events within 30 days after emergency-department assessment of syncope.

Clinical use: Use for patients aged 16 years or older presenting within 24 hours of syncope. This score supports, but does not replace, clinical judgment, local pathways, and urgent evaluation of serious causes.

Clinical variables

Choose one response for every item, then calculate the score.

Please select an answer for every item before calculating the score.

Predisposition to vasovagal symptoms Triggered by a warm crowded place, prolonged standing, fear, emotion, or pain.

No 0 Yes −1

Heart disease history Coronary artery disease, atrial fibrillation/flutter, congestive heart failure, or valvular disease.

No 0 Yes +1

Systolic blood pressure <90 or >180 mmHg Use any systolic blood-pressure reading during the emergency-department visit.

No 0 Yes +2

Elevated troponin Troponin level above the 99th percentile of the normal population.

No 0 Yes +2

Abnormal QRS axis QRS axis less than −30° or greater than 100°.

No 0 Yes +1

QRS duration >130 ms

No 0 Yes +1

Corrected QT interval >480 ms

No 0 Yes +2

Emergency-department diagnosis Based on the emergency-department evaluation.

Vasovagal syncope −2 Neither 0 Cardiac syncope +2

Canadian Syncope Risk Score

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Possible score: −3 to +11

Awaiting inputs Select one answer for each item, then choose “Calculate score.”

Risk category	Score	30-day event rate
Very low	≤ −2	0.2%
Low	−1 to 0	0.7%
Medium	1 to 3	8.0%
High	4 to 5	19.2%
Very high	≥ 6	51.3%

Outcome includes serious arrhythmic and non-arrhythmic events within 30 days.
Use alongside emergency-department assessment and local clinical protocols.

Eligibility and exclusions

Use for patients aged 16 years or older presenting within 24 hours of syncope. Do not use for prolonged loss of consciousness (>5 minutes), persistent change in mental status, obvious witnessed seizure, major trauma, intoxication, language barrier, or head trauma causing loss of consciousness.

Reference: Thiruganasambandamoorthy V, et al. Multicenter Emergency Department Validation of the Canadian Syncope Risk Score. JAMA Internal Medicine. 2020;180(5):737–744. doi:10.1001/jamainternmed.2020.0288.

Canadian Syncope Risk Score

Clinical variables

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