Pediatric Syncope: National Hospital Ambulatory Medical Care Survey Results

• Published in: The Journal of emergency medicine 2012-10, Vol.43 (4), p.575-583
• Main Authors: Anderson, Jeffrey B., MD, MPH, Czosek, Richard J., MD, Cnota, James, MD, Meganathan, Karthikeyan, MS, Knilans, Timothy K., MD, Heaton, Pamela C., PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Ambulances - statistics & numerical data; Child; computed tomography; electrocardiogram; Electrocardiography - utilization; Emergency; Emergency Service, Hospital - statistics & numerical data; Female; Fluid Therapy - utilization; Guideline Adherence; Health Care Surveys; Hospitalization - statistics & numerical data; Humans; Insurance, Health - statistics & numerical data; Length of Stay; magnetic resonance imaging; Magnetic Resonance Imaging - utilization; Male; National Hospital Ambulatory Medical Care Survey; Practice Guidelines as Topic; Sex Factors; syncope; Syncope - diagnosis; Syncope - therapy; Tomography, X-Ray Computed - utilization; United States
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2012.01.020

Abstract Background Syncope is a common problem in children and adolescents. The diagnostic yield for most tests commonly used in the evaluation of pediatric patients with syncope is low. Study Objective To examine the epidemiology of pediatric patients presenting to United States (US) emergency departments (EDs) with a complaint of syncope and compare their initial management to published guidelines. Methods ED visits from the National Hospital Ambulatory Medical Care Survey for 2003–2007 for patients aged 7–18 years were analyzed. Outcome variables were diagnostic tests and management of patients presenting with syncope. Results There were 627,489 (95% confidence interval [CI] 527,237–727,722) ED visits for syncope (0.9% of all ED visits for patients aged 7–18 years). Patients presenting to the ED for syncope were more commonly female ( p < 0.01), adolescent (13–18 years) ( p < 0.01), covered by private insurance ( p = 0.01), and more likely to arrive to the ED by ambulance ( p < 0.01), compared to those presenting with other complaints. Only 58.1% (95% CI 50.3–66.0%) of syncope patients received an electrocardiogram, and 26.5% (95% CI 18.2–34.7%) received a computed tomography (CT) or magnetic resonance imaging (MRI) scan as part of their diagnostic work-up. Conclusions When evaluating pediatric patients presenting with syncope, there should be an increased use of the electrocardiogram to screen for underlying cardiac abnormalities. There should also be a tempered use of CT/ MRI imaging in this population.