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

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.