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

To assess the use, yield, and cost-effectiveness of diagnostic tests used in the evaluation of syncope in children.

A retrospective review of 169 pediatric patients presenting to a tertiary care center with new onset syncope was undertaken. Test results were considered diagnostic when an abnormal result correlated with the clinical diagnosis or a normal result was obtained during a syncopal episode. Costs were based on the hospital cost of testing for fiscal year 1999, using a relative value unit-based costing methodology and did not include professional fees or costs of hospitalization.

A total of 663 tests were performed at a cost of 180,128 dollars. Only 26 tests (3.9%) were diagnostic in 24 patients (14.2%). The average cost per patient was 1055 dollars, and the cost per diagnostic result was 6928 dollars. Echocardiograms, chest radiographs, cardiac catheterizations, electrophysiology studies, and serum evaluations were not diagnostic.

The evaluation of pediatric syncope remains expensive, and testing has a low diagnostic yield. An approach that focuses on the use of testing to verify findings from the history and physical examination or exclude life-threatening causes is justified.