Pediatric Syncope: Differential Diagnosis and Treatment, Identifying Cardiac Syncope | EB Medicine
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Syncope In Pediatric Patients: A Practical Approach To Differential Diagnosis And Management In The Emergency Department

April 2017

Abstract

Syncope is a condition that is often seen in the emergency department. Most syncope is benign, but it can be a symptom of a life-threatening condition. While syncope often requires an extensive workup in adults, in the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes. For low-risk patients, resource-intensive workups are rarely diagnostic, and add significant cost to medical care. This issue will highlight critical diseases that cause syncope, identify high-risk “red flags,” and enable the emergency clinician to develop a cost-effective, minimally invasive algorithm for the diagnosis and treatment of pediatric syncope.

Keywords: syncope, neurocardiogenic syncope, vasovagal syncope, hypertrophic cardiomyopathy, Long QT syndrome, Wolff-Parkinson-White syndrome, supraventricular tachycardia, Brugada syndrome, heart block, postural orthostatic tachycardia syndrome, psychogenic pseudosyncope, breath-holding, pediatric, child

Points

  • The biggest challenge for emergency clinicians is to evaluate whether a patient's syncope is from a benign or vasovagal etiology or from a more concerning cause, such as cardiac syncope.
  • Initial history should be brief and focused toward pertinent information, such as onset of symptoms, details of events, and underlying medical problems.

Pearl

  • In the pediatric population, critical questioning and simple, noninvasive testing is usually sufficient to exclude significant or life-threatening causes of syncope; for low-risk patients, resource-intensive workups are rarely diagnostic and add significant cost.
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