Abstract
Objective
The aim of this study was to evaluate emergency department (ED) management of childhood
syncope, focusing on diagnostic tests ordered, whether a reason for specific testing
was recorded, and hospital admission rates.
Methods
We reviewed ED records of patients aged 5 to 20 years who presented to a community
hospital ED with syncope or near-syncope over a 1-year period (April 1, 2004, to March
31, 2005). Patient charts were nonelectronic (paper). We reviewed the elements of
the recorded history and physical examination for each patient. The specific tests
ordered in the ED were classified into 3 general testing categories for each patient
as follows: (1) simple testing, with a hospital charge of $100 or less per test; (2)
expanded testing, more than $100 per test, with a recorded explanation; and (3) expanded
testing without a recorded explanation.
Results
The charts of 140 patients were reviewed. Of these, we excluded 27 based on exclusion
criteria, including history of neurologic disorders. The mean age of the remaining
113 patients was 14.8 ± 3.3 years. Most (80%) presented with syncope; 20% had near-syncope.
Ten percent were admitted to the hospital, over half for an electrocardiogram (ECG)
interpreted as abnormal by an ECG machine and/or the ED staff. Overall, 17.5% of patients
had simple testing, 32.5% had expanded testing with explanation, and 50% had expanded
testing without explanation. Patients with syncope were more likely than patients
with near-syncope to be in the expanded testing category (P < .008). The most commonly ordered tests in the ED in order of decreasing frequency
were electrolytes (90%), ECG (85%), complete blood count (80%), urinalysis, urinary
drug screen, or urinary human chorionic gonadotropin (76%), head computed tomography
(CT, 58%), and chest x-ray (37%). The most expensive of these tests was the head CT;
all head CT results were negative.
Conclusions
A relatively high number of our subjects were admitted (10%), most often because of
questions raised by the ECG. Although an ECG is widely recommended for pediatric syncope
presenting to the ED, this suggests that ECG interpretation by a pediatric cardiologist
would be helpful before the decision to admit is made. In addition, 58% of our subjects
had a head CT in the ED; all CT results were negative. This high percentage of head
CTs for pediatric syncope has not been previously reported.
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Article Info
Publication History
Accepted:
June 21,
2007
Received in revised form:
June 19,
2007
Received:
March 28,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
