UDK 616.8-009.83-053.2
ISSN 2466-2992 (Online) (2019) br.1-2, p. 15-27
COBISS.SR-ID 46865417
SYNCOPE AND / OR COLLAPSE IN PEDIATRIC PATIENTS
Biljana Radisavljević1, Tatjana Mićić1, Radica Krstić1, Snežana Mitrović1, Natalija Vuković2
1Emergency Medical Service Niš, Serbia
2Clinic for Anesthesiology and Intensive Therapy, Clinical Centre Niš, Serbia
Summary:
INTRODUCTION: Syncope and/or collapse is a condition that is often seen in emergency departments in adult patients, while it is much less common in children and adolescents. The incidence rate in the emergency department ranges from 1% to 3%1, with an incidence in the pediatric population of 0.1% to 0.5%2,3
AIM: To indicate the importance of syncope and/or collapse in the pediatric population.
DATA SOURCE AND MATERIAL SELECTION: Retrospective (review) analysis of the literature with determinants: syncope, collapse, pediatrics. The search was performed through: Pubmed, Medline and Cobson and published literature of the library of the Medical Faculty Nis.
RESULTS OF SYNTHESIS: Syncope and/or collapse are mostly benign but can also be a symptom of life-threatening conditions. Unlike adults, for children a good history, examination and non-invasive tests are usually sufficient to exclude significant and life-threatening conditions. For low-risk patients detailed examinations, which require resources, are rarely diagnostic but they are expensive in cost-benefit assessment. In this paper, we will present the most important conditions and diseases that cause syncope and/or collapse in children, point out the high-risk signs and symptoms of the so-called "red flags" as well as alleviating conditions called "green lights" that allow primary care physicians and emergency physicians in admission-triage wards to assess. We will also present minimally-invasive algorithm and approach in diagnosis and treatment of pediatric patients with syncope and/or collapse. Vasovagal/neurocardiogenic syncope (NCS) is found in the large percentage of patients. The greatest concern and caution is needed with patients who have structural or organic diseases of the heart. ECG is a non-invasive and important diagnostic method, especially in setting up possible differential diagnosis. To distinguish between vasovagal and cardiac syncope, in addition to the ECG, a great significance has the data on: (1) the history of syncope during exercise, (2) family history of heart disease and sudden cardiac death, (3) abnormalities in the physical finding in favor of heart disease. In adolescents, consider the possibility of poisoning, drug use, and in girls, perform a routine pregnancy test and/or ßHCG from blood and/or urine if there are indications.
CONCLUSION: Syncope and/or collapse is a common reason for visiting patients in the admission wards. The etiology can range from life-threatening heart disease to less significant benign conditions. There is a need for an algorithmic approach in the care of these patients that would improve efficiency and reduce the cost and duration of diagnostics and treatment. Evaluation of a patient with syncope and/or collapse must be individual for each patient.
Key words: syncope, collapse, pediatrics
Korespondencija/Correspondence
Biljana RADISAVLJEVIĆ
Zavod za hitnu medicinsku pomoć Niš,
Vojislava Ilića bb
Tel: +381638504064
E-mail: radisavljevicbiljana@gmail.com
