Article Sidebar

Submitted
August 26, 2018
Accepted
April 30, 2020
Published
December 31, 2020
Download
PDF
Statistic
Read Counter : 610 Download : 310

Downloads

Download data is not yet available.

Main Article Content

Abstract

Background


To evaluate the causes of syncope in the pediatric population, positive and negative etiological predictors, and examine the utilization and utility of specialist evaluations and diagnostic testing in the workup of syncope.


 


Methods


Retrospective chart review in a tertiary academic center.  


Results


750 pediatric patients presenting with syncope over a 5-year period were identified. 76% of patients received electrocardiograms, 36.9% had cardiology evaluations, 23.1% had neurology evaluations, 33.7% had echocardiograms, over 20% underwent neuroimaging, 23.5% had electroencephalograms (EEGs), and 73.6% had additional testing. Over half of all patients initially presented to the emergency department (52%), where they were significantly more likely to get head CTs (OR: 2.49) and additional testing (OR: 3.42). The majority of all testing and evaluations resulted in a diagnosis of neurally mediated syncope (NMS) (74%), while only 2.3% and 1.6% were attributed to cardiac and seizure diagnoses, respectively. Patients with a seizure diagnosis were significantly more likely to report shaking, abnormal movements, post-ictal confusion, and a family history of seizures; Patients with a cardiac diagnosis were significantly more likely to report symptoms with exertion, associated chest pain or palpitations, and an abnormal cardiac history.   


Conclusions


Our study demonstrates an opportunity to improve the variability and cost of care in pediatric patients presenting with syncope, as a majority of specialist evaluations, cardiac testing, neuroimaging, and EEGs are not helpful in determining etiology of syncope. We identified positive and negative predictors of more serious etiologies that can assist in the development of guidelines for managing pediatric syncope. 

Article Details

License

Copyright (c) 2020 Arayamparambil C Anilkumar, Mary Elizabeth Reed Shenk

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).

Author Biography

Arayamparambil C Anilkumar, University of Missouri

Dr. Arayamparambil  C Anilkumar is the Division Director of pediatric neurology and  Associate professor of Clinical Child health at the University of Columbia, who is board certified in Pediatrics, Neurology, Child Neurology and Epilepsy.

Dr. Anilkumar has extensive clinical experience in pediatrics and is an expert in the field of Pediatric Neurology and Epilepsy. 

How to Cite
Anilkumar, A. C., & Reed Shenk, M. E. (2020). Pediatric Syncope: Etiological Predictors and Utility of Diagnostic Testing. Journal of the International Child Neurology Association, 1(1). https://doi.org/10.17724/jicna.2020.154
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX

References

  1. Friedman NR, Ghosh D, Moodley M. Syncope and paroxysmal disorders other than epilepsy. In: Swaiman KF, Ashwal S, Ferriero DM, Schor NF. eds. Swaiman's Pediatric Neurology: Principles and Practice. 5th ed. Philadelphia: Elsevier Saunders; 2012:905-925.
  2. Fischer JW, Cho CS. Pediatric Syncope: Cases from the Emergency Department. Emergency Medicine Clinics of North America. 2010; 28(3):501-516. doi:10.1016/j.emc.2010.03.009.
  3. Strieper MJ. Distinguishing Benign Syncope from Life-Threatening Cardiac Causes of Syncope. Seminars in Pediatric Neurology. 2005; 12(1):32-38. doi:10.1016/j.spen.2005.01.001.
  4. Moodley M. Clinical Approach to Syncope in Children. Seminars in Pediatric Neurology. 2013; 20(1):12-17. doi:10.1016/j.spen.2012.12.003.
  5. Moya A, Sutton R, Ammirati F, et al., Task Force for the Diagnosis and Management of Syncope, European Society of Cardiology (ESC), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), Heart Rhythm Society (HRS). Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009; 30(21):2631–2671.
  6. Strickberger SA, Benson DW, Biaggioni I, et al., American Heart Association Councils on Clinical Cardiology, Cardiovascular Nursing, Cardiovascular Disease in the Young, and Stroke, Quality of Care and Outcomes Research Interdisciplinary Working Group, American College of Cardiology Foundation, Heart Rhythm Society, American Autonomic Society. AHA/ACCF Scientific Statement on the evaluation of syncope. Circulation. 2006; 113(2):316–327
  7. National Institute for Health and Clinical Excellence. Transient loss of consciousness (“blackouts”) management in adults and young people. NICE clinical guideline 109. NICE, London; 2010 http://guidance.nice.org.uk/CG109/NICEGuidance/pdf/English. Accessed June 23, 2018.
  8. Guse SE, Neuman MI, O’Brien M, et al. Implementing a Guideline to Improve Management of Syncope in the Emergency Department. Pediatrics. 2014; 134(5):e1413-e1421.
  9. Sanatani S, Chau V, Fournier A, Dixon A, Blondin R, Sheldon R.S. Canadian Cardiovascular Society and Canadian Pediatric Cardiology Association Position Statement on the Approach to Syncope in the Pediatric Patient. Canadian Journal of Cardiology 2017, 33 (2), pp. 189-198. https://doi.org/10.1016/j.cjca.2016.09.006
  10. Raucci U, Scateni S, Tozzi AE, Drago F, Giordano U, Marcias M, Faa F, Reale A. The availability and the adherence to pediatric guidelines for the management of syncope in the Emergency Department. J Pediatr. 2014 Nov; 165(5):967-72.e1. doi: 10.1016/j.jpeds.2014.06.064. Epub 2014 Aug 6.
  11. Roston, Thomas M. et al. A Population-Based Study of Syncope in the Young. Canadian Journal of Cardiology 2018; 34(2):195 - 201
  12. Shen W-K, Sheldon RS, Benditt DG, Cohen MI, Forman DE, Goldberger ZD, Grubb BP, Hamdan MH, Krahn AD, Link MS, Olshansky B, Raj SR, Sandhu RK, Sorajja D, Sun BC, Yancy CW, 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope, Journal of the American College of Cardiology. 2017. doi: 10.1016/j.jacc.2017.03.003