Screening Pediatric Patients in New-Onset Syncope (SPINS) Study

Abstract

Objectives. The primary objective is to determine the frequency of history findings associated with cardiac syncope. Second, to determine the frequency of abnormal electrocardiograms (EKG) in patients presenting with typical vasovagal syncope. Methods. Retrospective chart review from January 2006 to April 2017 of children aged 5 to 18 years presenting to the emergency department with a chief complaint of syncope. Target population was all patients with first episode of syncope and a documented EKG. Excluded patients were those with head trauma, drug intoxication, current pregnancy, seizure, and any endocrine problem. Patients with cardiac causes of syncope were identified by an abnormal EKG or echocardiogram. Specific history findings (past cardiac history, chest pain, palpitations, syncope with exercise, absence of prodrome with syncope) were compared with those with and without cardiac etiology of syncope. The possibility of missing a patient with cardiac cause of syncope based on specific history findings was identified. Results. Of the total 4115 visits of patients with chief complaints of syncope, 2293 patients (55.7%) met the inclusion criteria. Nine patients (0.39%) were identified with cardiac etiology of syncope. The remaining were determined to be of vasovagal origin. All patients with cardiac etiology of syncope were found to have one positive specific history findings. A total of 1972 patients were identified with absence of specific history findings; no patient had a cardiac etiology of syncope. Conclusions. This study identifies screening questions to identify cardiac syncope. Implementing these standard questions could potentially decrease resource utilization and time for evaluation as well as guide follow-up.