Emergent evaluation of syncope in children and adolescents
- Jack C Salerno, MD
Jack C Salerno, MD
- Associate Professor, Department of Pediatrics, Division of Cardiology, Arrhythmia and Pacing Services
- University of Washington School of Medicine
- Section Editors
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington School of Medicine
- John K Triedman, MD
John K Triedman, MD
- Section Editor — Pediatric Cardiology
- Professor of Pediatrics
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will review the serious and benign causes of syncope.
The causes of syncope in children and the evaluation of adults with syncope are discussed separately. (See "Causes of syncope in children and adolescents" and "Approach to the adult patient with syncope in the emergency department".)
DEFINITION AND CAUSES
Syncope is a sudden, brief loss of consciousness associated with loss of postural tone from which recovery is spontaneous . Approximately 15 percent of children experience a syncopal episode prior to the end of adolescence .
Syncope is a symptom that can be classified according to the underlying cause: autonomic (eg, vasovagal [neurocardiogenic], situational, and orthostatic syndromes), cardiac, metabolic, or a condition that mimics syncope (table 1). Based upon case series of pediatric patients evaluated in the emergency department setting, autonomic forms comprise up to 80 percent of cases [3-6]. Neurologic etiologies, such as seizures or migraine headaches, are present in up to 20 percent of patients. Life-threatening conditions such as hypoglycemia, heat illness, anaphylaxis, cardiac arrhythmia, or structural cardiac disease are relatively rare but occur frequently enough (1 to 2 percent of children) to warrant diagnostic consideration.
Causes of syncope and paroxysmal conditions that mimic syncope are discussed in more detail separately. (See "Causes of syncope in children and adolescents" and "Nonepileptic paroxysmal disorders in infancy" and "Nonepileptic paroxysmal disorders in children".)
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- DEFINITION AND CAUSES
- EVALUATION AND DECISION
- - Preceding events or precipitating factors
- - Description of the event
- - Past medical history
- - Family history
- Physical examination
- Ancillary studies
- - Electrocardiogram
- - Laboratory tests
- - Other studies
- INDICATIONS FOR REFERRAL OR ADMISSION
- DIAGNOSTIC APPROACH
- Prolonged loss of consciousness
- Transient loss of consciousness
- - Abnormal cardiac evaluation
- Abnormal ECG
- Abnormal cardiac examination
- - Normal cardiac examination
- SUMMARY AND RECOMMENDATIONS