To examine the epidemiology of pediatric patients presenting to United States (US) emergency departments (EDs) with a complaint of syncope and compare their initial management to published guidelines.
ED visits from the National Hospital Ambulatory Medical Care Survey for 2003-2007 for patients aged 7-18 years were analyzed. Outcome variables were diagnostic tests and management of patients presenting with syncope.
There were 627,489 (95 % confidence interval [CI] 527,237-727,722) ED visits for syncope (0.9 % of all ED visits for patients aged 7-18 years). Patients presenting to the ED for syncope were more commonly female (p < 0.01), adolescent (13-18 years) (p < 0.01), covered by private insurance (p = 0.01), and more likely to arrive to the ED by ambulance (p < 0.01), compared to those presenting with other complaints. Only 58.1 % (95 % CI 50.3-66.0 % ) of syncope patients received an electrocardiogram, and 26.5 % (95 % ?CI 18.2-34.7 % ) received a computed tomography (CT) or magnetic resonance imaging (MRI) scan as part of their diagnostic work-up.
When evaluating pediatric patients presenting with syncope, there should be an increased use of the electrocardiogram to screen for underlying cardiac abnormalities. There should also be a tempered use of CT/ MRI imaging in this population.