Abstract 18469: Syncope in the Pediatric Emergency Department - Can We Predict Cardiac Disease Based on History Alone?
Objective: The AHA published a statement on the evaluation of syncope in 2006 which stated that a "meticulous history" is of paramount importance when evaluating patients with an initial episode of syncope. However, little is known about which features of the history are most helpful in identifying children with undiagnosed cardiac syncope. Our objective was 1) to describe in a pediatric ED the burden of syncope due to cardiac disease and 2) to identify the historical features which are associated with an underlying cardiac diagnosis. We hypothesized that patients with cardiac syncope would present with at least two of the following four historical features: syncope with exercise, syncope preceded by palpitations, syncope without prodrome, or syncope with exercise preceded by chest pain.
Methods: Using a cohort of patients who presented with syncope to our pediatric ED between May 1, 2009 and February 28, 2013, we 1) performed a cross-sectional study to describe the burden of cardiac syncope and 2) determined the sensitivity and specificity of our identified historical features with regard to identifying patients with cardiac syncope.
Results: Of 3624 patients, 43.3% were male presenting at a mean age of 12.7 +/- 7.3 years. Of 67 (1.8%) with a cardiac diagnosis, 52 were previously known. Of the 15 new cardiac diagnoses, 12 were considered incidental. Three patients (0.11%) had a newly confirmed cardiac cause of syncope; two with supraventricular tachycardia and one with myocarditis. Among the three cases of cardiac syncope and 50 randomly selected cases of non-cardiac syncope, the respective sensitivity and specificity of the historical features were 67% and 100% for syncope with exercise, 100% and 98% for syncope preceded by palpitations, 67% and 70% for syncope without prodrome, and 67% and 100% for chest pain preceding syncope. Using the presence of at least 2 of the features as a marker for cardiac syncope yielded a sensitivity of 100% and specificity of 100%.
Conclusions: Our study represents the largest series of pediatric patients presenting with syncope to an ED and our data confirms that newly diagnosed cardiac causes of syncope are rare. Furthermore, use of a few specific historical features on initial interview can help guide further workup more precisely.
- © 2013 by American Heart Association, Inc.