Syncope Best Practices: A Syncope Clinical Practice Guideline to Improve Quality

Area of Science:

• Pediatric Cardiology
• Clinical Practice Guidelines
• Syncope Evaluation

Background:

• Syncope is a common presenting complaint in pediatric cardiology.
• Variability in diagnostic approaches and resource utilization exists for syncope evaluation.
• Standardized clinical practice guidelines (CPGs) aim to reduce practice variation.

Purpose of the Study:

• To assess the impact of a standardized CPG for pediatric syncope evaluation.
• To determine if the CPG decreased practice variability and resource utilization.
• To evaluate changes in diagnostic yields and costs associated with syncope workups.

Main Methods:

• Retrospective review of 1496 pediatric patients (3-21 years) presenting with syncope.
• Analysis of medical records before and after CPG implementation.
• Comparison of resource utilization, costs, and diagnostic outcomes.

Main Results:

• No significant difference in cardiac disease diagnosis (0.6% vs. 0.4%).
• No overall change in costs or resource utilization.
• Significant decrease in variability of echocardiogram ordering among physicians.

Conclusions:

• The CPG did not reduce already low costs but decreased echo utilization variability.
• Detailed history, physical exam, and ECG are sufficient for most pediatric syncope evaluations.
• Further testing beyond basic evaluation offers no additional benefit.