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. ​

References: 

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 medicine, 180(5), 737–744. https://doi.org/10.1001/jamainternmed.2020.0288

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. Circulation, 139(11), 1396–1406. https://doi.org/10.1161/CIRCULATIONAHA.118.036088