SW-RCT Implementation of Canadian Syncope Risk Score Based Practice Recommendations

Recruiting now · Not applicable

Conditions studied: Syncope

In brief

Syncope is a common reason for emergency department (ED) presentation. While often benign, some patients have serious and life-threatening underlying causes, both cardiac and non-cardiac, which may or may not be apparent at the time of the initial ED assessment. Identifying which patients will benefit from further investigation, ongoing monitoring and/or hospital admission is essential to reduce both adverse outcomes and high costs. The research team has spent over a decade developing the evidence base for a risk stratification tool directed at optimizing the accuracy of ED decisions: the Canadian Syncope Risk Score (CSRS). This tool is now ready for the final phase of its introduction into clinical practice, namely a robust, multicentre implementation trial of the CSRS-based practice recommendations to demonstrate its real-world effectiveness. These recommendations, if applied, could lead to reduction in hospitalization with only 6% of high-risk patients requiring hospitalization, shorter ED lengths of stay for the 76% of ED syncope patients who are at low risk for 30-day serious outcomes, and more standardized disposition decisions, specifically discharge of 18% of medium-risk patients after appropriate discussion. Hence, the investigators hypothesize that an important reduction in hospitalization and ED disposition time can be achieved by implementing the CSRS-based recommendations with potential improvements in patient safety. The overall objective of this study is to evaluate the effectiveness of the knowledge translation (KT) of the CSRS-based practice recommendations in multiple Canadian EDs using a stepped wedge cluster randomized trial (SW-CRT) on health care efficiency and patient safety.

Key facts

Study ID: NCT04972071
Run by: Ottawa Hospital Research Institute
People needed: 14400
Starts: 2023-09-18
Expected to finish: 2026-03-01
Last updated by the study team: 2025-03-27

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

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

You may not qualify if…

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 it is running

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

Full record on ClinicalTrials.gov

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