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A prospective evaluation of pediatric patients with syncope
T Lerman-Sagie1, P Lerman, M Mukamel
1Department of Pediatrics, Beilinson Medical Center, Petah Tikva, Israel.
Insights
Pediatric syncope, often vasodepressor or cardioinhibitory, is typically diagnosed through patient history. Advanced diagnostic tests are rarely needed for these common childhood fainting episodes.
Area of Science:
- Pediatrics
- Cardiology
- Neurology
Background:
- Syncope is a common concern in pediatric patients.
- Understanding the characteristics and diagnostic yield of tests for pediatric syncope is crucial.
Purpose of the Study:
- To characterize syncope in children.
- To evaluate the effectiveness of diagnostic tests for pediatric syncope.
Main Methods:
- Prospective evaluation of 58 children with syncope.
- Data collection on patient history, age, episode frequency, and family history.
- Diagnostic testing including oculocardiac reflex and head-up tilt test.
Main Results:
- A diagnosis was established in 91% of patients.
- Most common diagnoses were vasodepressor (31) and cardioinhibitory (13) syncope.
- Diagnosis was primarily based on history (45 cases).
Conclusions:
- Vasodepressor and cardioinhibitory syncope are the leading causes of fainting in children.
- Thorough patient history is the most effective diagnostic tool.
- Extensive and costly evaluations are infrequently required for pediatric syncope.
Abstract:
Fifty-eight children with syncope were evaluated prospectively to determine the characteristics of syncope in the pediatric age group and the yield of various diagnostic tests. The age at first syncope ranged from 0.5 to 15 years. Twenty-five children presented after a single episode and 33 after multiple episodes. Ten had a history of breath-holding spells. Nineteen had a family history of syncope. A diagnosis was established in 53 patients (91%): vasodepressor (31), cardioinhibitory (13), tussive (3), hyperventilation (2), and mixed syncope (4). In five patients (9%), the cause remained unknown. The diagnosis was established from the history in 45 cases, by a positive oculocardiac reflex in 11, and by the head-up tilt test in four. We conclude that the cause of most cases of pediatric syncope is vasodepressor or cardioinhibitory and can be diagnosed by good history-taking. Costly evaluations are rarely necessary.