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<< Syncope In Pediatric Patients: A Practical Approach To Differential Diagnosis And Management In The Emergency Department

Disposition

Admission is rarely indicated for patients presenting with syncope. After evaluation and stabilization in the ED, the vast majority of patients with syncope who have no red flags and are asymptomatic can be discharged home safely with supportive management and explanation of risk factors for future episodes. For patients with concerning cardiac findings, consulting cardiology from the ED is indicated to help establish safe disposition and further workup. The decision of inpatient admission, outpatient specialist referral, or discharge home with reassurance is dependent on the individual etiologies. Patients with NCS can be discharged home safely with instructions to watch for warning signs of a more worrisome syncopal etiology (ie, red flags for cardiac etiology), and to follow up with their primary care provider. Additionally, patients should receive instructions about adequate hydration and early identification of vasovagal symptoms. Routine inpatient evaluation of syncope is not warranted unless a specific etiology is being considered and is either dependent on further workup that cannot be performed in the ED (eg, echocardiograms at some institutions), or if their specific etiology (eg, myocarditis, dysrhythmias) pose significant risk of anticipated morbidity or mortality. When considering admission based on ECG findings, a review by a pediatric cardiologist may be useful; such practice may decrease unnecessary admissions.76,77

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