Two scores for risk stratification of adults presenting with syncope may be effective at identifying those with low risk

1. The Canadian Syncope Risk Score (CSRS) and FAINT score are effective at identifying which adult patients presenting to the emergency department (ED) are at low risk for short-term adverse outcomes.

Evidence Rating Level: 2 (Good)

Syncope and presyncope account for 2-3% of all ED visits, with approximately 10% of these patients having serious underlying conditions such as arrhythmia, myocardial infarction, structural heart disease, pulmonary embolism, or severe hemorrhage. Previous studies showed that as many as one-third to one-half of these conditions were not identified during ED evaluation, leading to the development of tools such as the CSRS and FAINT score. This prospective, observational, multicenter cohort study performed external validation of these two scores in a United States population. Participants included adults aged 40 years or older presenting with syncope or presyncope who did not have a serious diagnosis identified during their ED visit. The study population had 1263 patients (mean [SD] age, 64.8 [13.1] years; 53.5% female). CSRS and FAINT scores were calculated for each patient, and physicians were asked to provide an unstructured estimate of the risk of the patient experiencing a serious adverse outcome within 30 days, collected as single values from 0% to 100%. The primary outcomes were identical to those in the original CSRS and FAINT studies. The primary outcome for FAINT was a serious cardiac outcome (death, significant cardiac arrhythmia, acute myocardial infarction, new serious structural heart disease, or a significant cardiac intervention) within 30 days of the ED visit. The primary outcome for CSRS was a serious cardiac or non-cardiac outcome (serious cardiac outcomes listed above in addition to aortic dissection, pulmonary embolism, severe hemorrhage, subarachnoid hemorrhage, cerebellar stroke, and other serious conditions causing syncope (including sepsis) and procedural interventions for the treatment of syncope) within 30 days of the ED visit. Of the 1263 patients, 74 (5.9%) had a serious adverse outcome, and 62 (4.9%) had a serious cardiac outcome. The CSRS area under the receiver operating characteristic curve (AUROC) was 0.72 (95% CI, 0.67-0.78). A low-risk score (CSRS <0) had a sensitivity of 91.9% (95% CI, 85.7%-98.1%) and an NPV of 97.5% (95% CI, 96.4%-98.8%). The FAINT score AUROC for a serious cardiac outcome was 0.76 (95% CI, 0.71-0.81). A low-risk score (FAINT = 0) had a sensitivity of 96.7% (95% CI, 92.4%-100%) and an NPV of 98.8% (95% CI, 98.0%-99.7%). The FAINT score, but not the CSRS, was more sensitive than physician-estimated risk (difference, 18.7%; 95% CI, 6.8%-30.6%; P = .002). While the CSRS and FAINT scores identified patients at low risk for adverse outcomes, only the FAINT score outperformed physicians at identifying patients at low risk for serious cardiac outcomes.

Click here to read this study in JAMA Network Open

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