ROSE Rule for Syncope

Stratifies an adult presenting to the emergency department with syncope by the risk of a serious outcome or death from any cause within 1 month, flagging any patient who meets one or more BRACES criteria for admission — a risk-stratification aid, not a diagnosis, and it requires a measured serum BNP to apply.

BNP (B-type natriuretic peptide) (pg/mL) — criterion met if ≥ 300

Heart rate — lowest recorded in ED or pre-hospital (bpm) — criterion met if ≤ 50

Hemoglobin (g/dL) — enter g/dL, not g/L; criterion met if ≤ 9.0

Oxygen saturation on room air (%) — criterion met if ≤ 94

Rectal exam — fecal occult blood (R)

Chest pain associated with the syncope (C)

ECG: pathological Q wave in any lead except lead III (E)