Electrocardiogram in Pediatric Syncope: Practice Variation Among Pediatric Emergency Physicians.

Area of Science:

• Pediatric Emergency Medicine
• Cardiology
• Clinical Practice Patterns

Background:

• Vasovagal syncope is common in pediatrics, but its evaluation in the emergency department can vary.
• Electrocardiograms (ECGs) are frequently used, but their role and interpretation in low-risk pediatric syncope are debated.
• Physician decision-making regarding ECGs and subsequent management in pediatric syncope requires further investigation.

Purpose of the Study:

• To assess emergency department physician practices and motivations for ordering ECGs in pediatric vasovagal syncope.
• To determine if borderline ECG findings influence management decisions in pediatric syncope.
• To explore factors influencing the decision to perform or not perform an ECG.

Main Methods:

• A cross-sectional survey was distributed to emergency physicians in the Pediatric Emergency Research Canada network.
• The survey included clinical vignettes of typical vasovagal syncope and cardiac syncope presentations.
• Physicians' investigation choices, consultation patterns, and disposition decisions were analyzed, along with factors influencing ECG performance.

Main Results:

• The response rate was 47% (105/225).
• In low-risk syncope, 51% ordered an ECG, and 45% modified management for non-normal ECGs.
• In high-risk syncope, 100% ordered an ECG, and 94% consulted cardiology.

Conclusions:

• Significant practice variation exists in evaluating and managing pediatric vasovagal syncope.
• Physician management is influenced by patient, provider, and institutional factors.
• The perceived clinical significance of borderline ECG findings impacts management decisions in pediatric syncope.