Cost of Unnecessary Testing in the Evaluation of Pediatric Syncope

Syncope is a common and a typically benign clinical problem in children and adolescents. The majority of tests ordered in otherwise healthy pediatric patients presenting with syncope have low diagnostic yield. This study quantifies testing and corresponding patient charges in a group of pediatric patients presenting for outpatient evaluation for syncope. Patients seen between 3/2011 and 4/2013 in the multi-disciplinary Syncope Clinic at Cincinnati Children's Hospital Medical Center were enrolled in a registry which was reviewed for patient information. The electronic medical record was used to determine which syncope patients underwent cardiac (electrocardiogram, echocardiogram, or exercise testing) or neurologic (head CT/MRI or electroencephalogram) testing within the interval from 3 months before to 3 months after the Syncope Clinic visit. Testing charges were obtained through hospital billing records. 442 patients were included for analysis; 91% were Caucasian; 65.6% were female; median age was 15.1 years (8.1-21.2 years). Cardiac and neurologic testing was common in this population. While some testing was performed during the Syncope Clinic visit, 46% of the testing occurred before or after the visit. A total of $1.1 million was charged to payers for cardiac and neurological testing with an average total charge of $2488 per patient. Despite the typically benign etiology of pediatric syncope, patients often have expensive and unnecessary cardiac and/or neurologic testing. Reducing or eliminating this unnecessary testing could have a significant impact on healthcare costs, especially as the economics of healthcare shift to more capitated systems.