Related Experiment Videos
Evaluation of recurrent pediatric syncope: role of tilt table testing
M J Strieper1, D O Auld, J E Hulse
1Children's Heart Center, Egleston Children's Hospital, Emory University, Atlanta, GA.
Insights
Early tilt table testing significantly improves diagnosis rates for pediatric syncope, reducing the need for extensive and costly investigations. This approach is highly effective for identifying neurocardiogenic syncope.
Area of Science:
- Pediatric Cardiology
- Diagnostic Testing
- Syncope Evaluation
Background:
- Recurrent syncope is a common concern in pediatric patients.
- The diagnostic pathway for pediatric syncope can be extensive and costly.
- The role of specific diagnostic tools, like tilt table testing, needs clarification.
Purpose of the Study:
- To assess current practices in evaluating recurrent syncope in children.
- To determine the effectiveness of diagnostic strategies, including tilt table testing.
- To establish the utility of tilt table testing in the pediatric syncope workup.
Main Methods:
- Retrospective analysis of 54 pediatric patients with syncope.
- Group I: 27 patients evaluated without tilt table testing.
- Group II: 27 patients evaluated with tilt table testing.
Main Results:
- Group II patients underwent more diagnostic studies per person compared to Group I.
- Only 1.6% of non-tilt table studies yielded abnormal results.
- Diagnosis was achieved in 100% of Group II patients versus 18.5% in Group I, primarily identifying neurocardiogenic syncope.
Conclusions:
- Extensive workups are often unnecessary for pediatric syncope suggestive of neurocardiogenic causes.
- Early integration of tilt table testing enhances diagnostic yield.
- Tilt table testing can prevent the need for numerous, expensive, and anxiety-provoking tests.
Objective:
To determine the current practice and effectiveness of evaluating recurrent syncope in pediatric patients, and to establish the role of tilt table testing in the evaluation.
Design:
Retrospective analysis of 54 pediatric patients with the history of syncope referred to cardiologists. Group I consisted of 27 patients examined without tilt table testing; group II consisted of 27 patients whose examination included tilt table testing.
Results:
Group I had an average of 5.4 studies and group II, 6.6 studies performed per patient. Studies included chest radiograph (16 vs 13), electrocardiogram (24 vs 27), echocardiography (21 vs 27), 24-hour electrocardiogram (14 vs 16), transtelephonic monitor (7 vs 8), electrophysiology study (1 vs 3), complete blood cell counts (11 vs 12), chemistries (10 vs 11), thyroid function test (3 vs 3), neurology consult (12 vs 6), electroencephalogram (12 vs 5), and head computed tomographic scan (5 vs 3). Of the 298 non-tilt studies, the results of only 5 (1.6%) were abnormal. Diagnoses were made in 5 (18.5%) of 27 group I patients (Wolff-Parkinson-White syndrome, 1; conversion reaction, 2; hyperventilation, 1; migraines, 1), whereas diagnosis was made in 27 (100%) of 27 group II patients (neurocardiogenic syncope, 25; conversion reaction, 2).
Conclusion:
An extensive workup is not routinely indicated in syncopal patients with a history consistent with neurocardiogenic syncope. Tilt table testing performed early in the evaluation will increase the probability of a diagnosis, and will often prevent the need for further extensive, expensive anxiety-producing tests.