Prospective analysis of syncope/pre-syncope in a tertiary paediatric orthopaedic fracture outpatient clinic

The incidence of vasovagal syncope (VVS) precipitated by medical procedures such as blood donation is quoted as between 0.13% and 4.17%. Vasovagal events have been observed to occur following cast removal at our paediatric orthopaedic clinic; however, there is no available information in the existing literature regarding incidence or risk factors. This study aims to identify the incidence and demographic traits of patients experiencing syncopal events following cast removal.

Over a 12-month period, paediatric patients experiencing a syncopal or pre-syncopal event during an outpatient appointment for cast removal were prospectively enrolled into the study. Basic demographic data were recorded, as well as injury and procedure details and a description of the event. Statistical analysis as well as calculation of incidence of vasovagal events were performed.

A total of 6078 patients presented for cast removal in the 12-month period. Twenty syncopal or pre-syncopal events were recorded. Incidence was calculated as 0.32%. Mean patient age was 10.8 years. Male : female ratio was 2.3:1. Mean body mass index (BMI) was 20.08, with a trend for higher prevalence of males under the 50th BMI percentile-for-age. The mean time post-injury was 31.4 days. Ninety-five percent of patients were being treated for an upper limb injury and 30% had injuries that had been treated surgically. There were no associated secondary complications or injuries.

Incidence of VVS following cast removal is comparable to the values quoted in literature for other medical procedures. Demographic data of our cohort suggested that those who experienced VVS were predominantly young males of lower-than-average BMI.