Practice variation and resource use in the evaluation of pediatric vasovagal syncope: are pediatric cardiologists over-testing?

Pediatric Cardiology
Erik R JohnsonShaji C Menon

Abstract

Syncope is a common problem in children and adolescents. Usually vasovagal in etiology, this benign problem often results in considerable testing and expense. We sought to define the current practice, practice variation, and resource utilization as well as evaluate a screening strategy for syncope at an academic tertiary care center. We reviewed the medical records of all patients age 8 to 19 years who presented with syncope between January 1994 and January 2012 and collected data regarding demographics, history, physical examination, and diagnostic tests. Practice variation was evaluated based on provider experience and subspecialty. The sensitivity and specificity of history, physical examination, and electrocardiogram (ECG) to identify a cardiac cause for syncope were calculated. Of the 617 patients studied, a cardiac cause for syncope was found in 15 (2 %). A screening strategy consisting of history, physical examination, and ECG was 100 % sensitive and 55 % specific for diagnosing a cardiac cause for syncope. Despite having a negative screen, 314 (54 %) patients had a total of 334 additional tests at an average charge of $983/patient. Although practice variation existed, it was not explained by provider experience or elect...Continue Reading

References

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Citations

Dec 19, 2015·Congenital Heart Disease·Heather M PhelpsMatthew E Oster
May 18, 2016·Emergency Medicine Australasia : EMA·Ben LawtonTessa Davis
Jul 24, 2015·Archives of Disease in Childhood. Education and Practice Edition·Michael Harris, Frances Bu'Lock
Feb 21, 2016·Journal of the American Heart Association·Yvonne ParisUNKNOWN New England Congenital Cardiology Association (NECCA)
Apr 25, 2018·Cardiology in the Young·Mark J CartoskiPhilip J Spevak
Mar 6, 2016·Pediatric Emergency Care·Timothy HoreczkoAngelo Milazzo
Mar 7, 2020·BMC Pediatrics·Björn ReynissonEstelle Naumburg
Jan 4, 2021·Pediatric Cardiology·Juan VillafaneDevyani Chowdhury
Jan 14, 2021·Wiener medizinische Wochenschrift·Katharina LandwehrMartin Poryo
Feb 15, 2021·Pediatric Cardiology·Melissa M WinderCollin G Cowley

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