We analyzed the cause of syncope and diagnostic workup of 226 consecutive pediatric patients seen in our emergency department because of a syncopal event.
Neurocardiogenic syncope and neurologic disorders were the most common diagnoses (80 % and 9 % , respectively). Other causes included psychologic, cardiac, respiratory, toxicologic, and metabolic problems. The neurocardiogenic and disease-related syncopes were easily identified or suspected by history and physical examination. Electrocardiography was not performed in 132 cases (58 % ). Most patients with suspected neurocardiogenic syncope had an electroencephalogram, and 29 % were admitted to the hospital. Cardiac disorders represented 5 cases (2 % ); 2 had been previously misdiagnosed.
Syncope in children can result from a wide variety of causes. Consequently, an evaluation that fails to approach this problem in a goal-directed fashion proves to be very expensive, time-consuming, and frustrating to all concerned. Thorough history and physical examination are usually all that are necessary to guide practitioners in choosing the diagnostic tests that apply to a given patient.