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. 2021 May;171(7-8):157-164.
doi: 10.1007/s10354-020-00798-3. Epub 2021 Jan 13.

[Syncope in children and adolescents: are the current guidelines being followed?]

[Article in German]
Katharina Landwehr  1   2 , Sascha Meyer  1   3 , Marina Flotats-Bastardas  3 , Martin Poryo  4
Affiliations

[Syncope in children and adolescents: are the current guidelines being followed?]

[Article in German]
Katharina Landwehr et al. Wien Med Wochenschr. 2021 May.

Abstract
in English, German

Background: Syncope in childhood and adolescence is frequent and in most cases benign. A thorough history taking, complete physical examination, electrocardiography and further diagnostic work-up as indicated should rule out possible cardiac syncope.

Objective: To evaluate whether the diagnosis of syncope was performed according to the currently valid S2k guideline.

Material and methods: Retrospective study (January 2015-December 2017), University Children's Hospital of Saarland, Homburg, Germany. All patients aged 1-18 years presenting with the primary complaint of syncope were included.

Results: In this study 262 patients presented with a history of syncope (161 female (61.5%), 101 male (38.5%), median age 12.5 ± 3.9 years). Of these, 183 (69.8%) were reflex syncopes, 36 (13.7%) presyncopes, 35 (13.4%) undefined and 8 (3.1%) cardiac syncope. Out of 262 patients, 43 (16.4%) were diagnosed in accordance with the published guidelines and 13/43 (30.2%) correctly received further diagnostic work-up. In 219/262 patients (83.6%) basic diagnostic testing was not sufficient and 135/219 (61.6%) were submitted to further unnecessary diagnostic tests.

Conclusion: Better adherence to the syncope guidelines bears the potential to avoid unnecessary and costly auxiliary medical tests while correctly diagnosing patients with syncope.

Zusammenfassung: HINTERGRUND: Synkopen im Kindes‑/Jugendalter sind häufig und meist gutartig. Mögliche kardiale Synkopen müssen durch sorgfältige Basisdiagnostik (Anamnese (I), körperliche Untersuchung (II), Elektrokardiografie (III)) und ggf. weiterführender Diagnostik ausgeschlossen werden.

Fragestellung: Wurde die Diagnostik bei Vorliegen einer Synkope entsprechend der gültigen S2k-Leitlinie durchgeführt?

Material und methoden: Retrospektive Analyse (01/2015–12/2017), Kinderklinik des Universitätsklinikums des Saarlandes, Homburg, Deutschland. Eingeschlossen wurden alle Patienten von 1 bis 18 Jahre, die sich wegen Synkope vorstellten.

Ergebnisse: Es erlitten 262 Patienten eine Synkope (161 weiblich [61,5 %], 101 männlich [38,5 %], Alter 12,5 ± 3,9 Jahre); davon 183 (69,8 %) Reflexsynkopen, 36 (13,7 %) Präsynkopen, 35 (13,4 %) Synkopen unklarer Genese, 8 (3,1 %) kardiale Synkopen; 43/262 Patienten (16,4 %) erhielten eine vollständiger Basisdiagnostik (I–III) gemäß Leitlinie, 13/43 (30,2 %) wurden korrekt weiterführender Diagnostik zugeführt; 219/262 Patienten (83,6 %) erhielten keine ausreichende Basisdiagnostik (I–III), 135/219 (61,6 %) wurden unnötigen apparativen Untersuchungen zugeführt.

Diskussion: Die leitlinienkonforme Synkopenabklärung ist wichtig, um unnötige, aber auch nicht ausreichende Diagnostik zu vermeiden und somit Patienten mit Synkope korrekt zu diagnostizieren.

Keywords: Basic diagnostic testing; Children and adolscents; Guideline; Red flags; Syncope.

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References

Literatur

Verwendete Literatur
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