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

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 present...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2014-11, Vol.134 (5), p.e1413-e1421
Main Authors: Guse, Sabrina E, Neuman, Mark I, O'Brien, Megan, Alexander, Mark E, Berry, Mark, Monuteaux, Michael C, Fine, Andrew M
Format: Article
Language:English
Subjects:
Adolescent
Analysis
Care and treatment
Child
Children & youth
Company business management
Disease Management
Emergency medical care
Emergency service
Emergency Service, Hospital - standards
Emergency Service, Hospital - trends
Fainting
Female
Follow-Up Studies
Hospital emergency services
Hospitals
Humans
Intervention
Male
Management
Pediatrics
Practice guidelines (Medicine)
Practice Guidelines as Topic - standards
Retrospective Studies
Syncope - diagnosis
Syncope - therapy
Young Adult
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Summary: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. 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. 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. 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.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2013-3833