What is the yield of screening echocardiography in pediatric syncope?

Objective. To determine the yield of screening echocardiography in the eval uation of pediatric syncope. Design. All patients diagnosed with syncope from January 1993 to January 19 99 were identified and their records were reviewed for age, weight, sex, ye ar of presentation, personal and family history, physical examination, and cardiac diagnostic testing. Cardiac defects were identified by reviewing ec hocardiograms and reports. Results. The 480 patients (268 females) ranged in age from 1.5 to 18.0 year s old and ranged in weight from 10.3 to 113.6 kg. Final diagnoses included noncardiac causes in 458, long QT syndrome in 14, arrhythmias in 6, and car diomyopathy in 2. An abnormal history, physical examination, or electrocard iogram identified 21 of the 22 patients with a cardiac cause of syncope. Of the 322 (67%) echocardiograms performed, abnormalities were detected in 37 . These abnormalities included 26 minor valve anomalies, 7 hemodynamically insignificant shunt lesions, 2 mildly decreased left ventricular shortening fractions, and 2 cardiomyopathies. Only the 2 cardiomyopathies were consid ered to be potential causes of syncope, and in both cases, the electrocardi ogram was markedly abnormal. A similar percentage of echocardiograms were o rdered during the first and last 3 years of the study (61% vs 71%). Conclusion. History, physical examination, and electrocardiography provide a screening protocol that allows the identification of a cardiac cause of s yncope in the overwhelming majority of pediatric patients. In the absence o f a positive screen result, the echocardiogram does not contribute to the e valuation of syncope in children. We speculate that primary care providers and pediatric cardiologists continue to use echocardiography because of the paucity of data regarding its value in pediatric syncope. However, this st udy shows little benefit of screening echocardiography and should discourag e its routine use.