💓 ROSE Rule (ED Syncope)
UseWhen to use: adult ED syncope when BNP and basic labs/ECG are available.
StrataHigh-risk ROSE favors further evaluation/admission pathways; negative is lower but not zero risk.
LimitsWhen not to use: without ECG / vitals. · Pitfall: skipping rectal exam when GI bleed is not suspected (score 0… · Complements SF Syncope / Canadian Syncope / Boston.
SourceReed MJ, et al. JACC 2010 (ROSE)
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
BRACES mnemonic.
When to use
When to use: adult ED syncope when BNP and basic labs/ECG are available.
How it works
Any of: BNP≥300; HR≤50; +FOB; Hb≤90 g/L; chest pain with syncope; Q wave (not III); SpO₂≤94% RA.
Key points
- BRACES mnemonic.
- Any positive = high risk.
- Next: SF syncope / Canadian CSR / EGSYS.
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.
| B — BNP ≥ 300 pg/mL | No (0) |
|---|---|
| R — Bradycardia ≤ 50 bpm in ED or prehospital | No (0) |
| A — Rectal examination shows fecal occult blood (if suspicion of GI bleed) | No / not indicated (0) |
| C — Anemia: hemoglobin ≤ 90 g/L (9 g/dL) | No (0) |
| E — Chest pain associated with syncope | No (0) |
| E — ECG with Q wave (excluding lead III) | No (0) |
| S — Oxygen saturation ≤ 94% on room air | No (0) |
→ROSERule-negative — lower risk band
- Positive criteria：0
| B — BNP ≥ 300 pg/mL | Yes |
|---|---|
| R — Bradycardia ≤ 50 bpm in ED or prehospital | Yes |
| A — Rectal examination shows fecal occult blood (if suspicion of GI bleed) | Yes — positive FOB |
| C — Anemia: hemoglobin ≤ 90 g/L (9 g/dL) | Yes |
| E — Chest pain associated with syncope | Yes |
| E — ECG with Q wave (excluding lead III) | Yes |
| S — Oxygen saturation ≤ 94% on room air | Yes |
→ROSEHigh risk — any BRACES positive
- Positive criteria：7
- Mnemonic：BRACES
Verification & sources · governance
FAQ
Frequently asked questions
- Does ROSE Rule (ED Syncope) 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 ROSE Rule (ED Syncope) calculated in practice? Can you show a worked example?
- Inputs: B — BNP ≥ 300 pg/mL No (0), R — Bradycardia ≤ 50 bpm in ED or prehospital No (0), A — Rectal examination shows fecal occult blood (if suspicion of GI bleed) No / not indicated (0), C — Anemia: hemoglobin ≤ 90 g/L (9 g/dL) No (0), E — Chest pain associated with syncope No (0), E — ECG with Q wave (excluding lead III) No (0), S — Oxygen saturation ≤ 94% on room air No (0) → Result: ROSE Rule-negative — lower risk band（Positive criteria: 0） Inputs: B — BNP ≥ 300 pg/mL Yes, R — Bradycardia ≤ 50 bpm in ED or prehospital Yes, A — Rectal examination shows fecal occult blood (if suspicion of GI bleed) Yes — positive FOB, C — Anemia: hemoglobin ≤ 90 g/L (9 g/dL) Yes, E — Chest pain associated with syncope Yes, E — ECG with Q wave (excluding lead III) Yes, S — Oxygen saturation ≤ 94% on room air Yes → Result: ROSE High risk — any BRACES positive（Positive criteria: 7, Mnemonic: BRACES）