MDCalc

ROSE (Risk Stratification of Syncope in the Emergency Department) Rule

Predicts 1-month serious outcome or death in patients presenting with syncope.

This tool has not been externally validated.

BNP Level ≥300 pg/mL

Bradycardia

≤50 bpm in ED or pre-hospital

Rectal examination showing fecal occult blood

If suspicion of gastrointestinal bleed

Anemia

Hemoglobin ≤90 g/L

Chest pain

Associated with syncope

ECG showing Q wave

Not in lead III

Saturation ≤94% on room air

Result:

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Advice

  • As with all clinical decision rules, do not base management solely on this score; correlate with clinical judgment.

  • Any one positive ROSE criterion classifies the patient as high risk for 30-day serious outcome or all-cause death.

Management
  • Any criterion present: Admit or observe with continuous monitoring and pursue a targeted evaluation based on signs, symptoms, and initial workup.
  • No criteria present: 
    • If the overall presentation is reassuring (e.g., normal vitals, no structural heart disease), consider discharge with prompt outpatient follow-up, education, and clear return precautions.
    • If clinical concern remains, consider admission and further workup.
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