title: Pediatric syncope: National Hospital Ambulatory Medical Care Survey results.
abstract: BACKGROUND
  Syncope is a common problem in children and adolescents. The diagnostic yield for most tests commonly used in the evaluation of pediatric patients with syncope is low.
  
  
  OBJECTIVE
  To examine the epidemiology of pediatric patients presenting to United States (US) emergency departments (EDs) with a complaint of syncope and compare their initial management to published guidelines.
  
  
  METHODS
  ED visits from the National Hospital Ambulatory Medical Care Survey for 2003-2007 for patients aged 7-18 years were analyzed. Outcome variables were diagnostic tests and management of patients presenting with syncope.
  
  
  RESULTS
  There were 627,489 (95% confidence interval [CI] 527,237-727,722) ED visits for syncope (0.9% of all ED visits for patients aged 7-18 years). Patients presenting to the ED for syncope were more commonly female (p<0.01), adolescent (13-18 years) (p<0.01), covered by private insurance (p=0.01), and more likely to arrive to the ED by ambulance (p<0.01), compared to those presenting with other complaints. Only 58.1% (95% CI 50.3-66.0%) of syncope patients received an electrocardiogram, and 26.5% (95% CI 18.2-34.7%) received a computed tomography (CT) or magnetic resonance imaging (MRI) scan as part of their diagnostic work-up.
  
  
  CONCLUSIONS
  When evaluating pediatric patients presenting with syncope, there should be an increased use of the electrocardiogram to screen for underlying cardiac abnormalities. There should also be a tempered use of CT/MRI imaging in this population.
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45255, USA.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Anderson
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Czosek
authors.forename: James
authors.initials: J
authors.lastname: Cnota
authors.forename: Karthikeyan
authors.initials: K
authors.lastname: Meganathan
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Knilans
authors.forename: Pamela C
authors.initials: PC
authors.lastname: Heaton
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000552:Ambulances / Q000706:statistics & numerical data; D002648:Child; D004562:Electrocardiography / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D019983:Guideline Adherence; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D007902:Length of Stay; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D017410:Practice Guidelines as Topic; D012737:Sex Factors; D013575:Syncope / Q000175:diagnosis* / Q000628:therapy*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014481:United States