A framework to simplify paediatric syncope diagnosis
File(s)
Published version
Author(s)
Stewart, Julian M
van Dijk, J Gert
Balaji, Seshadri
Sutton, Richard
Type
Journal Article
Abstract
This paper aims to improve the diagnosis of syncope and transient loss of consciousness (TLOC) in children. Diagnostic problems stem, first, from some causes spanning various disciplines, e.g. cardiology, neurology and psychiatry, while the most common cause, vasovagal syncope, is not embraced by any specialty. Second, clinical variability is huge with overlapping signs and symptoms. Third, the approach to TLOC/syncope of the European Society of Cardiology (ESC) is underused in childcare. We explain the ESC guidelines using an additional paediatric literature review. Classification of TLOC and syncope is hierarchic and based on history taking. Loss of consciousness (LOC) is defined using three features: abnormal motor control including falling, reduced responsiveness and amnesia. Adding a < 5 min duration and spontaneous recovery defines TLOC. TLOC simplifies diagnosis by excluding long LOC (e.g. some trauma, intoxications and hypoglycaemia) and focussing on syncope, tonic–clonic seizures and functional TLOC. Syncope, i.e. TLOC due to cerebral hypoperfusion, is divided into reflex syncope (mostly vasovagal), orthostatic hypotension (mostly initial orthostatic hypotension in adolescents) and cardiac syncope (arrhythmias and structural cardiac disorders). The initial investigation comprises history taking, physical examination and ECG; the value of orthostatic blood pressure measurement is unproven in children but probably low. When this fails to yield a diagnosis, cardiac risk factors are assessed; important clues are supine syncope, syncope during exercise, early death in relatives and ECG abnormalities.
Date Issued
2023-11-01
Date Acceptance
2023-07-11
Citation
European Journal of Pediatrics, 2023, 182 (11), pp.4771-4780
ISSN
0340-6199
Publisher
Springer
Start Page
4771
End Page
4780
Journal / Book Title
European Journal of Pediatrics
Volume
182
Issue
11
Copyright Statement
© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/37470792
PII: 10.1007/s00431-023-05114-w
Subjects
Childcare
CHILDREN
Diagnosis
EPILEPSY
Life Sciences & Biomedicine
MANAGEMENT
ORTHOSTATIC HYPOTENSION
Pediatrics
Risk
Science & Technology
Seizures
SEIZURES
SPELLS
Syncope
Unconsciousness
Publication Status
Published
Coverage Spatial
Germany
Date Publish Online
2023-07-20