Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology. J Am Heart Assoc 2016 Feb 19;5(2)
Date
02/21/2016Pubmed ID
26896480Pubmed Central ID
PMC4802448DOI
10.1161/JAHA.115.002931Scopus ID
2-s2.0-85002926284 (requires institutional sign-in at Scopus site) 27 CitationsAbstract
BACKGROUND: Pediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs).
METHODS AND RESULTS: Ambulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5-year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise-related or more problematic symptoms. Guideline-defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow-up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach.
CONCLUSIONS: SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low-severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention.
Author List
Paris Y, Toro-Salazar OH, Gauthier NS, Rotondo KM, Arnold L, Hamershock R, Saudek DE, Fulton DR, Renaud A, Alexander ME, New England Congenital Cardiology Association (NECCA)Author
David Saudek MD Associate Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAlgorithms
Ambulatory Care
Cardiology
Cardiovascular Diseases
Child
Critical Pathways
Decision Support Techniques
Delivery of Health Care
Electrocardiography
Female
Guideline Adherence
Humans
Male
Medical History Taking
New England
Pediatrics
Physical Examination
Practice Guidelines as Topic
Predictive Value of Tests
Prognosis
Program Evaluation
Regional Health Planning
Risk Assessment
Risk Factors
Severity of Illness Index
Syncope
Young Adult
