A broad set of criteria developed to identify ED syncope patients who require hospital admission. More sensitive than the San Francisco Syncope Rule, designed to ensure no high-risk patients are missed.

Parameters

Cardiac Risk Features

Abnormal ECGNew ECG abnormalities: new ischemic changes, LBBB, Mobitz II or complete AV block, prolonged QTc, pre-excitation, significant arrhythmia.Symptoms Suggesting Cardiac DiseaseChest pain, shortness of breath, or palpitations preceding syncope.History of Structural Heart DiseaseKnown CAD, cardiomyopathy (dilated, hypertrophic, ARVC), valvular disease, congenital heart disease, or heart failure.Systolic BP < 90 mmHg at PresentationHemodynamically unstable at ED arrival.Family History of Sudden Cardiac Death < 50 YearsFirst-degree relative with sudden unexplained death before age 50.

Signs of Significant Illness

Signs of Volume DepletionGI bleeding, dehydration (clinical or lab evidence), or active hemorrhage.New Neurological Symptoms or Focal DeficitsPost-event neurological deficits, focal weakness, dysarthria, visual changes — possible TIA or stroke.Hematocrit < 30%Significant anemia on ED workup.

Situational or Contextual High-Risk Features

Syncope with ExertionLoss of consciousness during or immediately following physical activity.Syncope in Supine PositionLoss of consciousness while lying flat — suggests non-vasovagal, arrhythmic, or structural cause.Sudden Syncope Without Prodrome or WarningAbrupt, unprovoked loss of consciousness without premonitory symptoms (no nausea, diaphoresis, light-headedness).

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CalculatorsBoston Syncope Criteria

CardiologyCriteria

Boston Syncope Criteria

A broad set of criteria developed to identify ED syncope patients who require hospital admission. More sensitive than the San Francisco Syncope Rule, designed to ensure no high-risk patients are missed.

Parameters

Cardiac Risk Features

Abnormal ECGNew ECG abnormalities: new ischemic changes, LBBB, Mobitz II or complete AV block, prolonged QTc, pre-excitation, significant arrhythmia.Symptoms Suggesting Cardiac DiseaseChest pain, shortness of breath, or palpitations preceding syncope.History of Structural Heart DiseaseKnown CAD, cardiomyopathy (dilated, hypertrophic, ARVC), valvular disease, congenital heart disease, or heart failure.Systolic BP < 90 mmHg at PresentationHemodynamically unstable at ED arrival.Family History of Sudden Cardiac Death < 50 YearsFirst-degree relative with sudden unexplained death before age 50.

Signs of Significant Illness

Signs of Volume DepletionGI bleeding, dehydration (clinical or lab evidence), or active hemorrhage.New Neurological Symptoms or Focal DeficitsPost-event neurological deficits, focal weakness, dysarthria, visual changes — possible TIA or stroke.Hematocrit < 30%Significant anemia on ED workup.

Situational or Contextual High-Risk Features

Syncope with ExertionLoss of consciousness during or immediately following physical activity.Syncope in Supine PositionLoss of consciousness while lying flat — suggests non-vasovagal, arrhythmic, or structural cause.Sudden Syncope Without Prodrome or WarningAbrupt, unprovoked loss of consciousness without premonitory symptoms (no nausea, diaphoresis, light-headedness).

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