Rule 3 (Boston Syncope Rule) – ESC guideline + San Francisco Syncope Rule + expert advice: for prediction of adverse events97 see Appendix D1 for more detailsRule 4 (ROSE rule): for prediction of adverse events182
  • Signs/symptoms of acute coronary syndrome, including chest pain and complaint of shortness of breath
  • B-type natriuretic peptide (BNP) level at least 300 pg/ml (marker for heart failure and cardiac disease)
  • Family history of sudden death, HOCM, Brugada’s, or long QT
  • Valvular heart disease (including heart murmur in history or on examination)
  • Signs of conduction disease, including syncope during exercise
  • ECG showing Q-waves (25% R wave) / left bundle branch block
  • Volume depletion, including GI bleed by haemoccult or history and haematocrit < 30%
  • rectal examination showing faecal occult blood (if suspicion of gastrointestinal bleed)
  • Persistent (more than 15min) abnormal vital signs, including bp < 90 mm Hg
  • Oxygen saturation 94% or less on room air
  • Primary CNS event
  • Anaemia – haemoglobin level 90 g/l or less
Any one of the above.Any one of the above

From: 3, Initial assessment and diagnosis of people who had TLoC

Cover of Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young People
Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young People [Internet].
NICE Clinical Guidelines, No. 109.
National Clinical Guideline Centre for Acute and Chronic Conditions (UK).
Copyright © National Clinical Guideline Centre for Acute and Chronic Conditions, 2010.

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