A PROSPECTIVE EVALUATION OF PEDIATRIC-PATIENTS WITH SYNCOPE

Fifty-eight children with syncope were evaluated prospectively to dete rmine the characteristics of syncope in the pediatric age group and th e yield of various diagnostic tests. The age at first syncope ranged f rom 0.5 to 15 years. Twenty-five children presented after a single epi sode and 33 after multiple episodes. Ten had a history of breath-holdi ng spells. Nineteen had a family history of syncope. A diagnosis was e stablished in 53 patients (91%): vasodepressor (31), cardioinhibitory (13), tussive (3), hyperventilation (2), and mixed syncope (4). In fiv e patients (9%), the cause remained unknown. The diagnosis was establi shed from the history in 45 cases, by a positive oculocardiac reflex i n 11, and by the head-up tilt test in four. We conclude that the cause of most cases of pediatric syncope is vasodepressor or cardioinhibito ry and can be diagnosed by good history-taking. Costly evaluations are rarely necessary.