Syncope in children and adolescents

Area of Science:

• Pediatrics
• Emergency Medicine
• Neurology

Background:

• Fainting (syncope) is a common reason for emergency department visits in children and adolescents.
• Accurate diagnosis is crucial for appropriate management and to rule out serious underlying conditions.

Purpose of the Study:

• To analyze the causes of syncope and near-syncope in pediatric patients presenting to the emergency department.
• To identify key diagnostic evaluations for first-episode syncope in this population.

Main Methods:

• Retrospective review of emergency department records for 77 children and adolescents with chief complaint of fainting.
• Categorization of patients into syncope, near-syncope, or no episode based on clinical review.
• Analysis of diagnostic outcomes and initial evaluation findings.

Main Results:

• Of 57 patients with syncopal or near-syncopal episodes, 40 had syncope and 17 had near-syncope.
• Common diagnoses for syncope included vasovagal syncope (50%) and orthostatic hypotension (20%).
• Common diagnoses for near-syncope included lightheadedness (29%) and seizure (18%).
• Abnormalities in vital signs, orthostatic vital signs, glucose, hematocrit, or ECG were found in 17.5% of syncopal patients, but none of the near-syncopal patients.

Conclusions:

• Vasovagal syncope and orthostatic hypotension are frequent causes of syncope in pediatric emergency department visits.
• Initial evaluation for first-episode syncope in children should incorporate orthostatic vital signs, glucose, hematocrit, and ECG.
• Further investigations should be guided by clinical findings and initial test results.