PT  - JOURNAL ARTICLE
AU  - Shenk, Mary Elizabeth Reed
AU  - Anilkumar, Arayamparambil
TI  - Syncope in Children: Etiology, Positive and Negative Predictors, and Utilization and Utility of Diagnostic Testing (P3.204)
DP  - 2017 Apr 18
TA  - Neurology
PG  - P3.204
VI  - 88
IP  - 16 Supplement
4099  - http://n.neurology.org/content/88/16_Supplement/P3.204.short
4100  - http://n.neurology.org/content/88/16_Supplement/P3.204.full
SO  - Neurology2017 Apr 18; 88
AB  - Objective: Evaluate the causes of syncope in the pediatric population, positive and negative etiological predictors, and examine the utilization and utility of specialist evaluations and diagnostic testing in the workup of syncope.Background: Syncope is a prevalent problem in the pediatric population. Most causes of syncope are benign, but the need to rule out more serious neurological and cardiovascular causes of syncope can result in a costly workup yielding low diagnostic value.Design/Methods: Retrospective chart review in a tertiary academic center.Results: 750 pediatric patients presenting with syncope over a 5-year period were identified. 76% of patients received electrocardiograms, 36.9% had cardiology evaluations, 23.1% had neurology evaluations, 33.7% had echocardiograms, over 20% underwent neuroimaging, 23.5% had electroencephalograms, and 73.6% had had additional testing. The majority of all testing and evaluations resulted were due to neurally mediated syncope (NMS). Over half of all patients initially presented to the Emergency Department (52%), where they were significantly more likely to get head CTs (OR: 2.49) and additional testing (OR: 3.42). Ultimately, 74% of diagnoses were identified as NMS while only 2.3% and 1.6% were attributed to cardiac and seizure diagnoses, respectively. Patients with a seizure diagnosis were significantly more likely to report shaking, abnormal movements, post-ictal confusion, and a family history of seizures; Patients with a cardiac diagnosis were significantly more likely to report symptoms with exertion, associated chest pain or palpitations, and an abnormal cardiac history; Both groups were significantly less likely to report orthostatic symptoms (alpha = 0.01).Conclusions: Our study demonstrates an opportunity to improve the variability and cost of care in pediatric patients, as majority of specialist evaluations, cardiac testing, neuroimaging, of EEGs are not helpful in determining etiology of syncope. We identified positive and negative predictors of more serious etiologies that can assist in the development of guidelines for managing pediatric syncope.Disclosure: Dr. Shenk has nothing to disclose. Dr. Anilkumar has nothing to disclose.