Implementing a risk score for patients with syncope in emergency departments

Multi-Centre Cluster-Randomized Implementation of Canadian Syncope Risk Score Based Practice Recommendations for Emergency Department Syncope Management

This study is testing a new scoring system in emergency departments to help doctors make better decisions for patients who faint, aiming to reduce unnecessary hospital stays.

Quick facts

• Phase: Not applicable
• Study type: Interventional
• Enrollment: 14400 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: Ottawa Hospital Research Institute (Academic / other)
• Locations: 15 sites (Calgary, Alberta and 14 other locations)
• Trial ID: NCT04972071 on ClinicalTrials.gov

What this trial studies

This clinical trial aims to implement the Canadian Syncope Risk Score (CSRS) in emergency departments across Canada to improve decision-making for patients presenting with syncope. The study will involve a stepped-wedge cluster randomized trial design, where 16 emergency department clusters will sequentially transition from usual care to the CSRS-based intervention over a total duration of 16 months. The primary focus is to assess the impact of this implementation on health resource utilization and patient outcomes, particularly in reducing unnecessary hospitalizations. The trial will also evaluate the effectiveness of knowledge translation strategies in enhancing the adoption of the CSRS recommendations in clinical practice.

Who should consider this trial

Good fit: Ideal candidates for this study are adults over 18 years old who present to the emergency department within 24 hours of experiencing syncope.

Not a fit: Patients who do not meet the criteria for syncope or have conditions such as prolonged loss of consciousness or seizures may not benefit from this study.

Why it matters

Potential benefit: If successful, this approach could significantly reduce unnecessary hospitalizations for patients with syncope while ensuring that high-risk patients receive appropriate care.

How similar studies have performed: Previous studies have shown promise in implementing risk stratification tools in emergency settings, suggesting that this approach could be effective.

Eligibility criteria

Physicians:

Inclusion criteria:

* ED physicians involved in ED syncope care
* Non-ED physicians involved in ED syncope care
* Physician's delegates involved in ED syncope care

Exclusion criteria:

* ED physicians not involved in ED syncope care
* Non-ED physicians not involved in ED syncope care
* Physician's delegates not involved in ED syncope care

Patients:

Inclusion criteria:

* Patients who are adults (aged \> 18 years)
* Patients who present to the ED within 24 hours of syncope.

Exclusion criteria:

* Patients who do not fulfill the definition of syncope, namely those with a prolonged loss of consciousness (i.e., \> 5 minutes), Glasgow Coma Scale \< 15 in patients without dementia (or a change in the mental status from baseline in those with dementia);
* Patients with witnessed obvious seizure, or head trauma preceding the loss of consciousness; and those who are unable to provide proper details (e.g., alcohol intoxication or other substance use).
* Patients who had a serious underlying for the syncope identified during the index ED evaluation and those who were consulted to an inpatient service or hospitalized for reasons other than syncope workup (e.g., social reasons such as inability to cope at home, pain due to the fall, significant trauma).

Where this trial is running

Calgary, Alberta and 14 other locations

• Foothills Medical Centre — Calgary, Alberta, Canada (Recruiting)
• St. Boniface Hospital — Winnipeg, Manitoba, Canada (Recruiting)
• Health Sicence North — Greater Sudbury, Ontario, Canada (Recruiting)
• Hawkesbury and District General Hospital — Hawkesbury, Ontario, Canada (Recruiting)
• London Health Sciences Centre — London, Ontario, Canada (Recruiting)
• North Bay Regional Health Centre — North Bay, Ontario, Canada (Recruiting)
• Thunder Bay Regional Health Sicences Centre — Thunder Bay, Ontario, Canada (Recruiting)
• University Health Network — Toronto, Ontario, Canada (Recruiting)
• Niagara Health — Welland, Ontario, Canada (Recruiting)
• Winchester District Memorial Hospital — Winchester, Ontario, Canada (Recruiting)
• Jewish General Hospital — Montreal, Quebec, Canada (Recruiting)
• Royal Victoria Hospital & Montreal General Hospital — Montreal, Quebec, Canada (Recruiting)
• Centre hospitalier de l'Université Laval — Québec, Quebec, Canada (Recruiting)
• Hotel Dieu Hospital of Lévis — Québec, Quebec, Canada (Recruiting)
• Hôpital de L'Enfant-Jésus — Québec, Quebec, Canada (Recruiting)

Study contacts

• Principal investigator: Venkatesh Thiruganasambandamoorthy, CCFP-EM, MSc — Ottawa Hospital Research Institute
• Study coordinator: Iris Nguyen, BSc

Conditions Syncope; Emergency Department; Risk Stratification