PT  - JOURNAL ARTICLE
AU  - Monica Solbiati
AU  - Giovanni Talerico
AU  - Paolo Villa
AU  - Franca Dipaola
AU  - Raffaello Furlan
AU  - Ludovico Furlan
AU  - Elisa Maria Fiorelli
AU  - Filippo Rabajoli
AU  - Ivo Casagranda
AU  - Katia Cazzola
AU  - Susanna Ramuscello
AU  - Andrea Vicenzi
AU  - Giovanni Casazza
AU  - Giorgio Costantino
TI  - Multicentre external validation of the Canadian Syncope Risk Score to predict adverse events and comparison with clinical judgement
AID  - 10.1136/emermed-2020-210579
DP  - 2021 Sep 01
TA  - Emergency Medicine Journal
PG  - 701--706
VI  - 38
IP  - 9
4099  - http://emj.bmj.com/content/38/9/701.short
4100  - http://emj.bmj.com/content/38/9/701.full
SO  - Emerg Med J2021 Sep 01; 38
AB  - Background The Canadian Syncope Risk Score (CSRS) has been proposed for syncope risk stratification in the emergency department (ED). The aim of this study is to perform an external multicenter validation of the CSRS and to compare it with clinical judgement.Methods Using patients previously included in the SyMoNE database, we enrolled subjects older than 18 years who presented reporting syncope at the ED. For each patient, we estimated the CSRS and recorded the physician judgement on the patients’ risk of adverse events. We performed a 30-day follow-up.Results From 1 September 2015 to 28 February 2017, we enrolled 345 patients; the median age was 71 years (IQR 51–81), 174 (50%) were men and 29% were hospitalised. Serious adverse events occurred in 43 (12%) of the patients within 30 days. The area under the curve of the CSRS and clinical judgement was 0.75 (95% CI 0.68 to 0.81) and 0.68 (95% CI 0.61 to 0.74), respectively. The risk of adverse events of patients at low risk according to the CSRS and clinical judgement was 6.7% and 2%, with a sensitivity of 70% (95% CI 54% to 83%) and 95% (95% CI 84% to 99%), respectively.Conclusion This study represents the first validation analysis of CSRS outside Canada. The overall predictive accuracy of the CSRS is similar to the clinical judgement. However, patients at low risk according to clinical judgement had a lower incidence of adverse events as compared with patients at low risk according to the CSRS. Further studies showing that the adoption of the CSRS improve patients’ outcomes is warranted before its widespread implementation.Data are available upon reasonable request. Data are available upon reasonable request to giorgic2@gmail.com.