💓 Boston Syncope Criteria
UseWhen to use: adult ED syncope disposition when structured high-risk screen is desired.
StrataHigh sensitivity screen in derivation; specificity moderate. Complements SF Syncope Rule.
LimitsWhen not to use: as the only risk tool without ECG/vitals review. · Pitfall: under-calling volume depletion or conduction disease. · Local admission pathways still govern.
SourceGrossman SA, et al. J Emerg Med 2007 (Boston Syncope)
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
8 domains; any = high risk.
When to use
When to use: adult ED syncope disposition when structured high-risk screen is desired.
How it works
Any of 8 domains: ACS signs; conduction disease; worrisome cardiac history; valvular disease; FH sudden death; persistent abnormal vitals; volume depletion; primary CNS event.
Key points
- 8 domains; any = high risk.
- Not a weighted points score.
- Next: SF Syncope / EGSYS / Canadian Syncope.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Signs/symptoms of acute coronary syndrome | No |
|---|---|
| Signs of conduction disease | No |
| Worrisome cardiac history (CAD, HF, low EF, etc.) | No |
| Valvular disease (history or exam) | No |
| Family history of sudden death | No |
| Persistent abnormal vital signs in ED | No |
| Volume depletion (e.g. GI bleed, Hct <30, uncorrected dehydration) | No |
| Primary CNS event | No |
→Boston SyncopeLow risk (0 domains)
- Positive domains：0/8
- Disposition cue：Discharge may be considered with follow-up
| Signs/symptoms of acute coronary syndrome | Yes |
|---|---|
| Signs of conduction disease | Yes |
| Worrisome cardiac history (CAD, HF, low EF, etc.) | Yes |
| Valvular disease (history or exam) | Yes |
| Family history of sudden death | Yes |
| Persistent abnormal vital signs in ED | Yes |
| Volume depletion (e.g. GI bleed, Hct <30, uncorrected dehydration) | Yes |
| Primary CNS event | Yes |
→Boston SyncopeHigh risk (≥1 domain)
- Positive domains：8/8
- Disposition cue：Admission/observation often favored
Verification & sources · governance
FAQ
Frequently asked questions
- Does Boston Syncope Criteria upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Boston Syncope Criteria calculated in practice? Can you show a worked example?
- Inputs: Signs/symptoms of acute coronary syndrome No, Signs of conduction disease No, Worrisome cardiac history (CAD, HF, low EF, etc.) No, Valvular disease (history or exam) No, Family history of sudden death No, Persistent abnormal vital signs in ED No, Volume depletion (e.g. GI bleed, Hct <30, uncorrected dehydration) No, Primary CNS event No → Result: Boston Syncope Low risk (0 domains)（Positive domains: 0/8, Disposition cue: Discharge may be considered with follow-up） Inputs: Signs/symptoms of acute coronary syndrome Yes, Signs of conduction disease Yes, Worrisome cardiac history (CAD, HF, low EF, etc.) Yes, Valvular disease (history or exam) Yes, Family history of sudden death Yes, Persistent abnormal vital signs in ED Yes, Volume depletion (e.g. GI bleed, Hct <30, uncorrected dehydration) Yes, Primary CNS event Yes → Result: Boston Syncope High risk (≥1 domain)（Positive domains: 8/8, Disposition cue: Admission/observation often favored）