Critically Appraised Topic: Syncope & Safe Discharge

Study #1: Multi-center Emergency Department Validation of the Canadian Syncope Risk Score 

- Large prospective cohort study performed at nine large Canadian Emergency Departments 

- Took place between 03/2014-04/2018 

- 3819 patients were enrolled and stratified into five categories based on the Canadian Syncope Risk Score (very low risk, low risk, medium risk, high risk, very high risk) 

- These patients were followed by chart review and phone interviews for thirty days

- Ultimately 139 patients had adverse outcomes

- This scoring system was 97.8% sensitive and 44.3% specific in predicting adverse outcomes in patients

- Confidence interval was 95%. 

Study #2: Duration of Electrocardiographic Monitoring of ED Patients with Syncope 

- This was a prospective cohort study performed at six large Canadian Emergency Departments

- Patient were stratified into three groups- low, medium, and high risk 

- Patients were followed for thirty days after initial visit

- 5581 patients were enrolled 

- 417 patients had adverse outcomes: low risk- .4%, medium risk- 8.7%, high risk- 25.3%

- Approximately half of the adverse outcomes were identified within 2 hours on telemetry for the low risk group and 6 hours for the medium and high risk groups 

- Of the adverse reactions that were missed in medium and high risk groups 90% were identified within 15 days post-discharge 

Conclusions: Low risk patients can be safely discharged after 2 hours on telemetry. Providers should have risk/benefit discussion with medium risk patients. If discharged they need close follow up. High risk patients should be observed overnight. ​


1.     Thiruganasambandamoorthy, V., Sivilotti, M., Le Sage, N., Yan, J. W., Huang, P., Hegdekar, M., Mercier, E., Mukarram, M., Nemnom, M. J., McRae, A. D., Rowe, B. H., Stiell, I. G., Wells, G. A., Krahn, A. D., & Taljaard, M. (2020). Multicenter Emergency Department Validation of the Canadian Syncope Risk Score. JAMA internal medicine180(5), 737–744.

2.     Thiruganasambandamoorthy, V., Rowe, B. H., Sivilotti, M., McRae, A. D., Arcot, K., Nemnom, M. J., Huang, L., Mukarram, M., Krahn, A. D., Wells, G. A., & Taljaard, M. (2019). Duration of Electrocardiographic Monitoring of Emergency Department Patients With Syncope. Circulation139(11), 1396–1406.