title: The availability and the adherence to pediatric guidelines for the management of syncope in the Emergency Department.
abstract: OBJECTIVE
  To evaluate the impact of the 2009 Italian pediatric clinical guidelines on the management of syncope.
  
  
  METHODS
  A retrospective study of patients who presented to the Emergency Department (ED) of Bambino Gesù Children's Hospital with syncope during the 2 years before and then for 2 years after the establishment of the Italian pediatric clinical guidelines. Implementation of the clinical guidelines included educational seminars, additional training of health care workers, and the availability of clinical guidelines and its algorithms on ED examination rooms.
  
  
  RESULTS
  We studied a population of 1073 patients (n = 470 vs n = 603). Most patients had neurocardiogenic syncope with a greater increase in postimplementation period (n = 241, 51.3% vs n = 454, 49.8%); we also noticed a parallel reduction of the number of patients with undefined syncope (30% vs 8.3%). We observed an increase in electrocardiogram (n = 328, 69.8% vs n = 512, 85.1%; P < .001), a reduction in electroencephalogram (n = 54, 11.5% vs n = 25, 4.1%; P < .001), and computed tomography scan/magnetic resonance imaging utilization (n = 26, 5.5% vs n = 8, 1.3%; P < .001). In addition, there was a significant reduction of hospital admission rates (n = 195; 41.5% vs n = 116, 19.2%; P < .001). The time period was significantly associated with improvements in all procedures at the multivariate analysis.
  
  
  CONCLUSIONS
  Providing practitioners in the ED with age-oriented clinical guidelines increased the efficiency of clinical management of pediatric syncope. Our study demonstrated that the implementation of pediatric clinical guidelines on syncope improve diagnosis, reduce hospital admissions, and decrease the use of unnecessary diagnostic tests.
authors.affiliation: Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. Electronic address: umberto.raucci@opbg.net.
authors.forename: Umberto
authors.initials: U
authors.lastname: Raucci
authors.affiliation: Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Scateni
authors.affiliation: Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Alberto Eugenio
authors.initials: AE
authors.lastname: Tozzi
authors.affiliation: Arrhythmology Service and Syncope Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drago
authors.affiliation: Sports Medicine Unit, Pediatric Cardiology and Cardiac Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: Giordano
authors.affiliation: Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Marcias
authors.affiliation: Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Faa
authors.affiliation: Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Reale
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019937:Diagnostic Techniques and Procedures / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013575:Syncope / Q000175:diagnosis*