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Pediatrics. 2014 Nov;134(5):e1413-21. doi: 10.1542/peds.2013-3833.

Implementing a guideline to improve management of syncope in the emergency department.

Author information

1
Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania;
2
Departments of Medicine, and.
3
Department of Emergency Medicine, George Washington University, Washington, District of Columbia.
4
Cardiology, Boston Children's Hospital, Boston, Massachusetts; and.
5
Departments of Medicine, and andrew.fine@childrens.harvard.edu.

Abstract

BACKGROUND AND OBJECTIVES:

Thirty-five percent of children experience syncope at least once. Although the etiology of pediatric syncope is usually benign, many children undergo low-yield diagnostic testing. We conducted a quality improvement intervention to reduce the rates of low-yield diagnostic testing for children presenting to an emergency department (ED) with syncope or presyncope.

METHODS:

Children 8 to 22 years old presenting to a tertiary care pediatric ED with syncope or presyncope were included. We excluded children who were ill-appearing, had previously diagnosed cardiac or neurologic disease, ingestion, or trauma. We measured diagnostic testing rates among children presenting from July 2010 through October 2012, during which time we implemented a quality improvement intervention. Patient follow-up was performed 2 months after the ED visit to ascertain subsequent diagnostic testing and medical care.

RESULTS:

A total of 349 patients were included. We observed a reduction in the rates of low-yield diagnostic testing after our quality improvement intervention: complete blood count testing decreased from 36% (95% confidence interval 29% to 43%) to 16% (12% to 22%) and electrolyte testing from 29% (23% to 36%) to 12% (8% to 17%). Performance of recommended testing increased, such as electrocardiograms and pregnancy testing in postpubertal girls. Despite a reduction in diagnostic testing among children with syncope, patients were not more likely to undergo subsequent diagnostic testing or seek further medical care following their ED visit.

CONCLUSIONS:

Implementation of a quality improvement intervention for the ED evaluation of pediatric syncope was associated with reduced low-yield diagnostic testing, and was not associated with subsequent testing or medical care.

KEYWORDS:

children; guideline; syncope

PMID:
25332499
DOI:
10.1542/peds.2013-3833
[Indexed for MEDLINE]
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