title: Syncope in the Pediatric Emergency Department - Can We Predict Cardiac Disease Based on History Alone?
abstract: BACKGROUND
  The American Heart Association recommends a "meticulous history" when evaluating patients with an initial episode of syncope. However, little is known about which historical features are most helpful in identifying children with undiagnosed cardiac syncope.
  
  
  OBJECTIVE
  Our objectives were 1) to describe the cardiac disease burden in Emergency Department (ED) syncope presentations, and 2) to identify which historical features are associated with a cardiac diagnosis.
  
  
  METHODS
  Using syncope presentations in our ED between May 1, 2009 and February 28, 2013, we 1) performed a cross-sectional study describing the burden of cardiac syncope, and 2) determined the sensitivity and specificity of four historical features identifying cardiac syncope.
  
  
  RESULTS
  Of 3445 patients, 44.5% were male presenting at 11.5 ± 4.5 years of age. Of patients with a cardiac diagnosis (68, ~2%), only 3 (0.09%) were noted to have a previously undiagnosed cardiac cause of syncope: 2 with supraventricular tachycardia and 1 with myocarditis. Among the three cases and 100 randomly selected controls, the respective sensitivity and specificity of the historical features were 67% and 100% for syncope with exercise, 100% and 98% for syncope preceded by palpitations, and 67% and 70% for syncope without prodrome. The presence of at least two features yielded a sensitivity of 100% and specificity of 100%.
  
  
  CONCLUSIONS
  Our study, which represents the largest published series of pediatric syncope presenting to the ED, confirms that newly diagnosed cardiac causes of syncope are rare. Using a few specific historical features on initial interview can help guide further work-up more precisely.
authors: Sibley Heart Center at Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors: David
authors: D
authors: Hurst
authors: Pediatric Emergency Medicine Associates, LLC, Atlanta, Georgia.
authors: Daniel A
authors: DA
authors: Hirsh
authors: Sibley Heart Center at Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia; Emory University Rollins School of Public Health, Atlanta, Georgia.
authors: Matthew E
authors: ME
authors: Oster
authors: Sibley Heart Center at Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors: Alexandra
authors: A
authors: Ehrlich
authors: Sibley Heart Center at Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors: Robert
authors: R
authors: Campbell
authors: Sibley Heart Center at Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors: William T
authors: WT
authors: Mahle
authors: Pediatric Emergency Medicine Associates, LLC, Atlanta, Georgia.
authors: Michael
authors: M
authors: Mallory
authors: Sibley Heart Center at Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
authors: Heather
authors: H
authors: Phelps
mesh_terms: D000293:Adolescent; D002637:Chest Pain / Q000209:etiology; D002648:Child; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D015444:Exercise; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008487:Medical History Taking; D009205:Myocarditis / Q000150:complications* / Q000175:diagnosis; D062706:Prodromal Symptoms; D012680:Sensitivity and Specificity; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology*; D013617:Tachycardia, Supraventricular / Q000150:complications* / Q000175:diagnosis
keywords: cardiac syncope; electrocardiogram; long QT syndrome; pediatric emergency department; screening; supraventricular tachycardia