Synkopenabklärung bei Kindern und Jugendlichen – Handeln wir gemäß der aktuellen Leitlinie?

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.