Modified Calgary score in differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope in children

Abstract

The present study was designed to analyse the usefulness of a modified Calgary score system during differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope through a large sample sized clinical investigation. The study included 213 children, including 101 boys and 112 girls, with cardiac syncope or postural orthostatic tachycardia syndrome-associated syncope in the age group of 2-19 years (mean 11.8 ± 2.9 years). A modified Calgary score was created, which was analysed to predict differential diagnoses between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope using a receiver operating characteristic curve. The median of modified Calgary scores for cardiac syncope was -5.0, which significantly differed from that of postural orthostatic tachycardia syndrome (0.0; p < 0.01). The sensitivity and specificity of a differentiation score of less than -2.5 was 96.3% and 72.7%, respectively. Owing to the fact that the modified Calgary score was an integer, when less than -3.0 the diagnosis could be considered as cardiac syncope. The modified Calgary score could be used to make an initial differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope in the clinic.

Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient

“…The distinction between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope could be helped with the use of the modified Calgary score for the pediatric population. 12 The median of modified Calgary scores for cardiac syncope was À5.0, which significantly differs from that of postural orthostatic tachycardia syndrome. The sensitivity and specificity of a differentiation score of less than À2.5 are 96.3% and 72.7%, respectively ( Table 2).…”

“…The sensitivity and specificity of a differentiation score of less than À2.5 are 96.3% and 72.7%, respectively ( Table 2). 12 Syncope associated with recent change of position, poor hydration or nutritional status, or a warm environment is usually VVS. The most common position in which VVS occurs is standing, although syncope when seated has also been observed.…”

2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents

“…For POTS, Jin et al first put forward a symptom score system (a modified Calgary score) to evaluate the outcome of POTS children [55]. The score system is recommended as an index for treatment efficacy and a score reduction of !2 points is considered effective [51].…”

Management of reflex anoxic seizures in children

“…Cardiogenic syncope, such as that caused by the prolonged QTc syndromes (the autosomal dominantly inherited Romano–Ward and autosomal recessively inherited Jervell and Lange-Nielsen syndromes) or other arrhythmias, usually occurs in older children although it may also occur in preschool children. Vigorous exercise rather than sudden pain is the characteristic trigger with syncope occurring during or just after exercise; episodes may also follow a sudden loud noise or severe emotional upset 10 11…”