Differential Diagnostic Models Between Vasovagal Syncope and Psychogenic Pseudosyncope in Children

Abstract

Objective: We aimed to establish useful models for the clinical differential diagnosis between vasovagal syncope (VVS) and psychogenic pseudosyncope (PPS). Methods: This bicentric study included 176 patients (150 VVS and 26 PPS cases) for model development. Based on the results of univariate and multivariate analyses, a logistic regression model and a scoring model were established and their abilities to differentiate VVS from PPS were tested. Another 78 patients (53 VVS and 25 PPS) were used for external validation. Results: In the logistic regression model, the outcome indicated that the QT-dispersion (QTd) (P < 0.001), syncope duration (P < 0.001), and upright posture (P < 0.001) acted as independent factors for the differentiation of VVS from PPS, which generated an area under the curve (AUC) of 0.892. A cutoff value of 0.234 yielded a sensitivity and specificity of 89.3 and 80.8%, respectively, for the differentiation between VVS and PPS in the logistic regression model. In the scoring model which consists of three variables, a cutoff score of three points yielded a sensitivity and specificity of 91.3 and 76.9%, respectively, with an AUC of 0.909. The external validation test indicated that the negative and positive predictive values of the scoring model were 78.8 and 91.7%, respectively, and the accuracy was 80.8%. Conclusion: The scoring model consisting of three variables is an easy-to-perform, inexpensive, and non-invasive measure for initial differential diagnosis between VVS and PPS.

Differential Diagnosis Between Psychogenic Pseudosyncope and Vasovagal Syncope in Children: A Quantitative Scoring Model Based on Clinical Manifestations

“…Therefore, the results of this study will be helpful to suggest reasonable referrals and optimize the differential diagnostic process in clinical practice. Furthermore, compared with the previous study ( 24 ), this scoring model, for the first time, used the clinical manifestations only instead of doing a variety of laboratory investigations at the initial diagnostic step, and the newly developed scoring model yielded relatively high sensitivity and specificity for differentiating PPS from VVS.…”

“…However, how to quantify these various clinical features and use them to discriminate between PPS and VVS is an urgent issue in clinical practice. In a previous study, the authors described a model composing of the posture during an episode, loss of consciousness (LOC) duration, and electrocardiogram-derived QT dispersion ( 24 ). However, the result of QT dispersion cannot be determined in a very quick and convenient way in grassroots hospitals.…”

The value of QT interval in differentiating vasovagal syncope from epilepsy in children

“…It indicates that this method can be used to evaluate the function of cardiac autonomic nerve. Zhang et al [ 19 ] through the Logical regression model analysis of 176 patients (150 VVS patients and 26 cardiogenic pseudosyncope patients), the results showed that QTd, syncope duration and upright posture could distinguish VVS from psychogenic pseudosyncope, in which the area under the QTd curve was 0.892. Cardiogenic pseudosyncope usually had no autonomic nervous dysfunction, which further indicated that QTd could reflect cardiac autonomic nervous function.…”

Pediatric syncope: pearls and pitfalls in history taking

“…Zhang et al [ 67 ] analyzed the clinical features of 150 children with VVS and 26 with pseudosyncope and established a scoring model that could differentiate between the 2 groups. This study evaluated clinical symptoms and ECG data and vital signs [ 67 ].…”