Syncope in children and adolescents

We retrospectively reviewed the emergency department records of 77 children and adolescents seen in an emergency department with the chief complaint of fainting. Upon careful review, 20 patients had not had any type of syncopal or near-syncopal episode. Of the remaining 57 patients, 40 experienced syncope, and 17 patients had near-syncope. The most frequent diagnoses in the syncopal patients were vasovagal syncope (50%), orthostatic hypotension (20%), atypical seizure (7.5%), migraine headache (5%), and minor head trauma (5%). The most frequent diagnoses in the near-syncope group were lightheadedness (29%), seizure (18%), tension headache (12%), and migraine (6%). Seventeen and one half percent of syncopal patients had abnormalities of vital signs, orthostatic vital signs, glucose, hematocrit, or ECG; none of the near-syncopal patients had abnormalities. We conclude that initial evaluation of first-episode syncope should include orthostatic vital signs, glucose, hematocrit, and ECG with further studies performed as clinically indicated.