Syncope in children: Diagnostic tests have a high cost and low yield

Steinberg, Leonard A.; Knilans, Timothy K.

doi:10.1016/j.jpeds.2004.10.039

Cited by 87 publications

(77 citation statements)

References 21 publications

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“…Previous studies have demonstrated that evaluations for patients with syncope have included serum laboratory studies, urine drug screens, electrocardiograms (ECGs), chest radiographs, brain computed tomography (CT) scans, brain MRI, electroencephalograms, echocardiograms, and 24-Holter monitoring. [6][7][8][9][10][11][12] One recent study showed 26% of these patients underwent head CT or MRI, and 38% received intravenous fluids. 13 In one ED-based pediatric study, laboratory testing was obtained in 122 (67%) of 181 patients 8 , and another study found that electrolyte testing was obtained in 90% of children, and a complete blood count (CBC) in 80%.…”

Section: Discussionmentioning

confidence: 99%

Implementing a Guideline to Improve Management of Syncope in the Emergency Department

Guse

Neuman²,

O’Brien

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVES: Thirty-five percent of children experience syncope at least once. Although the etiology of pediatric syncope is usually benign, many children undergo low-yield diagnostic testing. We conducted a quality improvement intervention to reduce the rates of low-yield diagnostic testing for children presenting to an emergency department (ED) with syncope or presyncope.METHODS: Children 8 to 22 years old presenting to a tertiary care pediatric ED with syncope or presyncope were included. We excluded children who were ill-appearing, had previously diagnosed cardiac or neurologic disease, ingestion, or trauma. We measured diagnostic testing rates among children presenting from July 2010 through October 2012, during which time we implemented a quality improvement intervention. Patient follow-up was performed 2 months after the ED visit to ascertain subsequent diagnostic testing and medical care.

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Section: Discussionmentioning

confidence: 99%

Implementing a Guideline to Improve Management of Syncope in the Emergency Department

Guse

Neuman²,

O’Brien

et al. 2014

Pediatrics

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“…There are ample data to support that typical neurally mediated syncope in the school‐age child and adolescent results in excessive testing,20, 21, 22 with a systematic trend toward more testing in the last 40 years 4. Adult groups have developed reasonable predictive rules; however, they also have disease incidence and severity that are orders of magnitude higher than seen in pediatrics 23.…”

Section: Discussionmentioning

confidence: 99%

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Paris

Toro‐Salazar

Gauthier

et al. 2016

JAHA

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BackgroundPediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs).Methods and ResultsAmbulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5‐year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise‐related or more problematic symptoms. Guideline‐defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow‐up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach.Conclusions SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low‐severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention.

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“…Otherwise, most tests are unlikely to produce diagnostic results [13]. Ambulatory (loop) ECG recorders should be used in patients with palpitations associated with syncope.…”

Section: Extended Assessmentmentioning

confidence: 99%