[Syncope and pre-syncope in children and adolescents: a prospective study in a pediatric emergency care unit].
OBJECTIVE
To assess in a pediatric emergency care unit (PECU): 1. The frequency of syncope and pre-syncope, 2. The incidence of diagnoses, 3. The value of investigations and cardiology and neurology consultations.


METHODS
The data of PECU patients aged 2 years to 15 years and 3 months were prospectively collected over 1 year. Standard electrocardiogram and serum glucose were compulsory investigations. Schellong's orthostatic test was performed whenever possible.


RESULTS
One hundred and fity-nine children (mean age, 11+/-4 years) were included, accounting for 0.8% of the PECU's visits: 48% had syncope, 52% had pre-syncope. The most common cause was neurally mediated syncope - 98 patients (62%), with vasovagal syncope for 80 patients - followed by neurological causes: 29 patients (18%). Neither cardiac arrhythmia nor obstructive cardiomyopathy was diagnosed. There were discrepancies between cardiologists' and pediatricians' ECG interpretations in 9% of cases. Diagnoses differed between cardiologists and pediatricians in 54% of 41 consultations. Diagnoses differed between neurologists and pediatricians in 54% of 42 consultations. No investigation except Schellong's orthostatic test led to modification of a previous diagnosis.


CONCLUSIONS
This study emphasizes that the routine workup of pediatric syncope should focus on the patient's history and physical examination. Diagnostic testing should be minimal: ECG and Schellong's orthostatic test. The leading cause was neurocardiogenic syncope.
Noizet-Yverneau
O
O
Service d'urgences pédiatriques, pôle de l'urgence, CHRU de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
Hue
V
V
Vaksmann
G
G
Cuvellier
J-C
JC
Lamblin
M-D
MD
Leclerc
F
F
Martinot
A
A
D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005602:France; D006331:Heart Diseases / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000175:diagnosis / Q000453:epidemiology; D015994:Incidence; D033183:Interdisciplinary Communication; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology; D010348:Patient Care Team; D011446:Prospective Studies; D012017:Referral and Consultation; D013575:Syncope / Q000097:blood / Q000453:epidemiology* / Q000209:etiology*; D019462:Syncope, Vasovagal / Q000175:diagnosis / Q000453:epidemiology; D014600:Utilization Review / Q000706:statistics & numerical data
D001786:Blood Glucose