Anderson Jeffrey B, Czosek Richard J, Cnota James, Meganathan Karthikeyan, Knilans Timothy K, Heaton Pamela C
The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45255, USA.
J Emerg Med. 2012 Oct;43(4):575-83. doi: 10.1016/j.jemermed.2012.01.020. Epub 2012 Mar 8.
Syncope is a common problem in children and adolescents. The diagnostic yield for most tests commonly used in the evaluation of pediatric patients with syncope is low.
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.
晕厥在儿童和青少年中是一个常见问题。在评估患有晕厥的儿科患者时，大多数常用检查的诊断率较低。
研究因晕厥主诉就诊于美国急诊科的儿科患者的流行病学情况，并将他们的初始治疗与已发表的指南进行比较。
分析了2003年至2007年国家医院门诊医疗调查中7至18岁患者的急诊就诊情况。结果变量为晕厥患者的诊断检查和治疗情况。
因晕厥就诊急诊的有627,489例（95%置信区间[CI]527,237 - 727,722）（占7至18岁患者所有急诊就诊的0.9%）。与因其他主诉就诊的患者相比，因晕厥就诊急诊的患者更常见为女性（p<0.01）、青少年（13 - 18岁）（p<0.01）、有私人保险覆盖（p = 0.01），且更可能通过救护车到达急诊（p<0.01）。只有58.1%（95%CI 50.3 - 66.0%）的晕厥患者接受了心电图检查，26.5%（95%CI 18.2 - 34.7%）接受了计算机断层扫描（CT）或磁共振成像（MRI）扫描作为其诊断检查的一部分。
在评估患有晕厥的儿科患者时，应增加使用心电图来筛查潜在的心脏异常情况。在这一人群中，CT/MRI成像的使用也应适度。
