Tools

COMPASS-31

Composite Autonomic Symptom Score

The COMPASS-31 (Composite Autonomic Symptom Score) is a 31-item self-report questionnaire that measures the severity of autonomic symptoms across six domains: orthostatic intolerance, vasomotor function, secretomotor function, gastrointestinal symptoms, bladder function, and pupillomotor function. It was developed at the Mayo Clinic and published by Sletten and colleagues in 2012 as a shorter, more practical version of the original 169-item Autonomic Symptom Profile.

It is widely used in both clinical practice and research to screen for dysautonomia and to track autonomic symptom burden over time. It has been validated in multiple languages and is referenced in studies on POTS, diabetic neuropathy, and post-viral autonomic dysfunction including long COVID.

The questionnaire generates a weighted total score from 0 to 100, with higher scores indicating greater symptom severity. Each domain is scored separately and then weighted according to the original validation, so the total reflects the relative clinical importance of different symptom areas rather than simply adding up raw answers.

If you have a post-viral condition, POTS, ME/CFS, or suspected dysautonomia, the COMPASS-31 can help you quantify your symptom burden in a structured way. It is particularly useful for tracking changes over time and for bringing a concrete, standardised summary to clinical appointments. If your main concern is POTS specifically, the Malmö POTS Symptom Score is a newer 12-item score built for POTS with a 7-day recall window, the Orthostatic Grading Scale grades orthostatic intolerance in five questions, the Vanderbilt Orthostatic Symptom Score is rated while standing, and the NASA lean test records the heart-rate data a POTS assessment requires.

This is a free, interactive version. Complete it below and receive your weighted score immediately, broken down by domain. No sign-up or email is required.

This is not a diagnostic tool. Your score reflects self-reported symptom severity and does not constitute a diagnosis of any condition. Scores should be discussed with your doctor or specialist. Based on: Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc. 2012;87(12):1196–1201.

Most questions ask about the past year. Some follow-up questions only appear if they apply to you, depending on your earlier answers.

Domain 1 Orthostatic intolerance

Symptoms that come on after standing up from sitting or lying down.

1. In the past year, have you felt faint, dizzy or muddled, or found it hard to think, soon after standing up from sitting or lying down?

2. When you stand up, how often do you get these feelings or symptoms?

3. How severe are these feelings or symptoms?

4. Over the past year, have these feelings or symptoms got:

Domain 2 Vasomotor

Changes in skin colour linked to blood flow.

5. In the past year, have you noticed colour changes in your skin, such as red, white or purple?

6. Which parts of your body are affected by these colour changes? Tick all that apply.

7. Are these skin colour changes getting:

Domain 3 Secretomotor

Sweating, and dryness of the eyes and mouth.

8. In the past five years, what change, if any, has there been in how much you sweat overall?

9. Do your eyes feel excessively dry?

10. Does your mouth feel excessively dry?

11. Thinking of whichever you've had longest, dry eyes or dry mouth, is it getting:

Domain 4 Gastrointestinal

Digestion and bowel function. The autonomic nervous system controls how the gut moves.

12. In the past year, has there been any change in how quickly you feel full when eating a meal?

13. In the past year, have you felt excessively or persistently full (bloated) after a meal?

14. In the past year, have you vomited after a meal?

15. In the past year, have you had cramping or colicky pain in your abdomen?

16. In the past year, have you had any bouts of diarrhoea?

17. How often do the bouts of diarrhoea happen?

18. How severe are the bouts of diarrhoea?

19. Are the bouts of diarrhoea getting:

20. In the past year, have you been constipated?

21. How often are you constipated?

22. How severe are the episodes of constipation?

23. Is the constipation getting:

Domain 5 Bladder

Bladder control and emptying.

24. In the past year, have you lost control of your bladder?

25. In the past year, have you had difficulty passing urine?

26. In the past year, have you had trouble emptying your bladder completely?

Domain 6 Pupillomotor

Light sensitivity and focusing, which depend on how the pupils respond.

27. In the past year, without sunglasses or tinted glasses, has bright light bothered your eyes?

28. How severe is this sensitivity to bright light?

29. In the past year, have you had trouble focusing your eyes?

30. How severe is this focusing problem?

31. Is your most troublesome eye symptom (sensitivity to bright light or trouble focusing) getting:

Understanding your COMPASS-31 score

What the score measures

It measures how much you are affected by symptoms of autonomic dysfunction: problems with the nerves that control heart rate, blood pressure, sweating, digestion, the bladder and the pupils. Its 31 questions fall into six domains, which are weighted and added up to a total from 0 to 100. Higher means more symptoms.

Orthostatic intolerance counts for up to 40 points, gastrointestinal 25, secretomotor 15, bladder 10, and vasomotor and pupillomotor 5 each. It was distilled at the Mayo Clinic from a longer questionnaire using the answers of 405 healthy volunteers (Sletten et al. 2012), then checked in 66 people being assessed for nerve damage (Treister et al. 2015).

Yes. It is widely used in POTS and long COVID research. In an online survey of 160 women with POTS, the average score was 55.3.

Score bands

There is no agreed normal range or cut-off. The paper that introduced the COMPASS-31 did not publish a normal range or severity bands.

Instead there are reference points from individual studies:

COMPASS-31 scores reported in published studies
ScoreWhat the study foundSource
10Screening cut-off for small fibre neuropathy: caught 93% of cases, but also flagged most people without itTreister 2015
20Threshold for moderate to severe symptoms; 66% of 2,314 adults with long COVID scored above itLarsen 2022
30Best cut-off for separating biopsy-confirmed small fibre neuropathy from noneTreister 2015
55.3Average among 160 women with POTS in an online surveyBlitshteyn 2024

A score of 30 is not a diagnosis. In a study of 66 people being assessed for small fibre neuropathy, 30 best separated those whose skin biopsy confirmed it from those whose did not, sorting about three in four of each group correctly.

What a change in score means

No minimal important change has been published, so there is no agreed number of points that counts as a real change. Scores were very consistent when people filled it in twice, two weeks apart. Most questions ask about the past year, so read changes over months, and look for a change that holds across several results.

What it does not measure

No. It measures the symptoms you report, not how your nerves actually work. A diagnosis needs a clinician and, for POTS, heart rate and blood pressure measured lying and standing. Specialist tests such as a tilt table measure function directly, and in one study COMPASS-31 scores agreed only moderately with them.

If your orthostatic score is high, the NASA lean test records the readings a POTS assessment uses, and the Malmö POTS score and Vanderbilt score focus on symptoms when upright. The plain-language guide to post-viral autonomic dysfunction explains how these symptoms fit together.

Taking this to your GP or consultant

Bring your total, the date, the six domain scores and, if you have one, the trend (the history above can be copied as text). Most GPs will not know the COMPASS-31, so say what it is: a validated 31-question measure of autonomic symptoms from the Mayo Clinic. Autonomic, cardiology and neurology specialists are more likely to recognise it. Use it to support a request for assessment, such as a lying and standing heart rate and blood pressure check, not as evidence of a diagnosis. See the 30 bpm threshold explainer and preparing for a GP appointment.

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