Cardiology Emergency Medicine

Boston Syncope Criteria

Identifies high-risk syncope features requiring hospital admission.

Signs or symptoms of acute coronary syndrome — chest pain of possible cardiac origin, ischaemic ECG changes, VT / VF / SVT / rapid AF or new ST-T changes, or shortness of breath*

Worrisome cardiac history — CAD or cardiomyopathy, heart failure or LV dysfunction, VT / VF, pacemaker or ICD, or antidysrhythmic drugs (other than beta-blockers or calcium-channel blockers)*

Family history (first-degree relative) of sudden death, HOCM, Brugada syndrome or long QT syndrome*

Valvular heart disease — heart murmur by history or on ED examination*

Signs of conduction disease — multiple syncopal episodes within 6 months, rapid heartbeat by history, syncope during exercise, QT > 500 ms, second- or third-degree heart block or intraventricular block*

Volume depletion — gastrointestinal bleeding, haematocrit < 30 %, or dehydration not corrected in the ED*

Persistent (> 15 min) abnormal vital signs in the ED without intervention — RR > 24, SpO₂ < 90 %, sinus rate < 50 or > 100, BP < 90 mmHg*

Primary central nervous system event (e.g. subarachnoid haemorrhage, stroke)*

Score interpretation

Low Risk 0

No Boston high-risk features. Low risk. Consider discharge.

→ Discharge with appropriate follow-up.

High Risk — Admit 1–8

≥ 1 Boston category present. Admission recommended (sensitivity 97 % for adverse outcome or critical intervention).

→ Admit for monitoring, further evaluation, and specialist review.

Interpretation bands for the Boston Syncope. Apply clinical judgement and local guidance.

References

Grossman SA, et al. Predicting adverse outcomes in syncope. J Emerg Med. 2007;33(3):233–239.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

📚 MRCEM Revision

Featured in these MRCEM clinical pathways

The Boston Syncope is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.

Syncope

MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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