title: Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology.
abstract: BACKGROUND
  Pediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs).
  
  
  RESULTS
  Ambulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5-year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise-related or more problematic symptoms. Guideline-defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow-up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach.
  
  
  CONCLUSIONS
  SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low-severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention.
authors.affiliation: Division of Pediatric Cardiology, Baystate Medical Center, Springfield, MA Department of Pediatrics, Tufts Medical School, Boston, MA.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Paris
authors.affiliation: Pediatric Cardiology, Connecticut Children's Medical Center, Hartford, CT Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT.
authors.forename: Olga H
authors.initials: OH
authors.lastname: Toro-Salazar
authors.affiliation: Pediatric Cardiology, Children's Hospital at Dartmouth-Hitchcock, Dover, NH Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, NH.
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Gauthier
authors.affiliation: Pediatric Cardiology, Hasbro Children's Hospital, Providence, RI Department of Pediatrics, Warren Alpert Medical School at Brown University, Providence, RI.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Rotondo
authors.affiliation: Pediatric Cardiology, Harvard Vanguard Medical Associates, Boston, MA.
authors.forename: Lucy
authors.initials: L
authors.lastname: Arnold
authors.affiliation: Institute for Relevant Clinical Data Analytics, Inc, Boston, MA.
authors.forename: Rose
authors.initials: R
authors.lastname: Hamershock
authors.affiliation: Pediatric Cardiology, Children's Hospital of Wisconsin, Milwaukee, WI Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: David E
authors.initials: DE
authors.lastname: Saudek
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: David R
authors.initials: DR
authors.lastname: Fulton
authors.affiliation: Institute for Relevant Clinical Data Analytics, Inc, Boston, MA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Renaud
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, MA Arrhythmia Service, Boston Children's Hospital, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA mark.alexander@cardio.chboston.org.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Alexander
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000553:Ambulatory Care / Q000458:organization & administration; D002309:Cardiology / Q000458:organization & administration* / Q000592:standards; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D002648:Child; D019091:Critical Pathways; D003661:Decision Support Techniques; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D004562:Electrocardiography; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008487:Medical History Taking; D009511:New England; D010372:Pediatrics / Q000458:organization & administration* / Q000592:standards; D010808:Physical Examination; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D015397:Program Evaluation; D012040:Regional Health Planning / Q000458:organization & administration* / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013575:Syncope / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D055815:Young Adult
keywords: adolescence; ambulatory care; pediatrics; syncope (fainting)