Syncope Risk Stratification — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] CSRS stratification
   After syncope evaluation — Canadian Syncope Risk Score (CSRS) stratification? (Transient loss of consciousness (cerebral hypoperfusion, rapid onset and recovery). ED must do: history (prodrome, trigger, posture, exertion, palpitations, family history of sudden death), orthostatic vitals, an ECG in all ± targeted tests; search for serious causes (arrhythmia/structural heart disease/ischemia, PE, hemorrhage, dissection, SAH). The Canadian Syncope Risk Score (CSRS, −3 to +11) predicts 30-day serious adverse events.)
   • High/very-high (≥4) → High/very-high risk
   • Medium (1–3) → Medium risk
   • Low/very-low (<1) → Low/very-low risk
2. [End] Low/very-low risk
   CSRS <1 (30-day serious adverse events ~0.4–1.2%): discharge with clear return advice (return immediately if symptoms worsen); most need no admission.
3. [End] Medium risk
   CSRS 1–3: shared decision-making — a period of observation/monitoring to look for an unrecognized serious cause; for those discharged, consider outpatient ambulatory ECG monitoring.
4. [End] High/very-high risk
   CSRS ≥4: admit and monitor, systematically evaluate serious causes — focus on excluding hemorrhage, PE, MI, life-threatening arrhythmia; ECG/telemetry, targeted tests (echo, troponin, etc.), manage by cause.

Source guidelines & references

• Canadian Syncope Risk Score CSRS (Thiruganasambandamoorthy 2020)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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