title: Comparison of short head-up tilt test with conventional protocol after omission of nonmedicated phase in children and young adults.
abstract: BACKGROUND
  Syncope is an important and common clinical condition, and the neurally mediated syncope is the most frequent type of syncope. Tilt testing is considered as a first-line diagnostic test.
  
  
  METHODS
  We conducted the conventional and modified tilt test on 200 subjects in the age range of 5-20 years. In conventional protocol, the patient was tilted for up to 15 min without medication. If syncope did not develop, the patient received 0.1 mg/kg sublingual isosorbide dinitrate. Then, the patient was continued to be tilted for another 15 min. In modified tilt test, before starting the test, the patient received 0.1 mg/kg isosorbide dinitrate sublingually in supine position. Then, the table was tilted for a maximum of 25 min or until the test became positive.
  
  
  RESULTS
  In conventional tilt test group 79.13% and in modified tilt test group 87.06% of subjects showed positive results. In conventional tilt test, the mean of response time was 17.67 ± 4.74 min. The mean of the total time of conventional tilt test was 49.81 ± 5.57 min. In modified tilt test, the mean of response time was 7.24 ± 4.83 min. The mean of the total time of modified tilt test was 35.09 ± 7.58 min. Furthermore, the means of both response and total times between two groups were significantly different (P< 0.001).
  
  
  CONCLUSIONS
  Our study showed that we can save about 15-20 min in total test time which may increase the cooperation and compliance of young patients and decrease their anxiety with this new protocol.
authors.affiliation: Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Bahar
authors.initials: B
authors.lastname: Dehghan
authors.affiliation: Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Sabri
keywords: Neurally mediated syncope; nitrates; tilt table testing