Standardized Approaches to the Investigation of Syncope: Canadian Cardiovascular Society Position Paper

Development of the Canadian Syncope Risk Score to predict serious adverse events after emergency department assessment of syncope

“…22 After multiple imputation, we dichotomized continuous predictors using a combination of clinical rationale and analysis of receiver operating characteristic curves, which identified the optimal cut-off point based on measures of sensitivity, specificity and the Youden Index. 12,17,18 After categorization, predictors selected by bivariable analysis were included in a multivariable logistic regression model, which was reduced by stepwise backward elimination with a 5% significance level to stay in the model. The regression estimates for the reduced model were combined across the 10 multiple imputation data sets.…”

“…16 We chose the list of variables for data collection on the basis of a comprehensive literature review, the results of previously completed studies and expert consensus. 15,[17][18][19] We identified a subset of these variables as candidate predictors for the study. When feasible, a second emergency physician assessed a subset of study patients to estimate interobserver agreement of the eligibility criteria and predictor variables.…”

Syncope Risk Stratification in the Emergency Department

“…Rules or risk scores may help the ED physician in decision making, although so far there is no compelling evidence that any score or rule performs better than personal clinical judgment in affecting patients' clinical outcomes. [10][11][12][13][14] …”

A 62-year-old woman with syncope

“…1,[5][6][7] Laboratory investigations may be considered if underlying causes, such as anemia, or metabolic disturbances, such as hypoglycemia or hypercapnia, are suspected. 4,8,9 Further cardiac investigations or admission to hospital for observation should be guided by the presence of red flags (Box 1).…”