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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.



Retrospective chart review in a tertiary academic center.  


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.   


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

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).


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