Epidemiological Characteristics and Clinical Outcome of Syncope in Children; A Report from Shiraz, Iran

Background: Syncope is a common problem among children.

Objectives: This cross-sectional study aimed to determine the epidemiological characteristics of children with syncope and clarify the outcome of managements in Imam Reza Pediatrics Cardiology Clinic affiliated to Shiraz University of Medical Sciences, the main referral center for pediatric patients with syncope in south of Iran.

Patents and Methods: This cross-sectional, descriptive–analytical study was conducted on all the children referred with transient loss of consciousness and positive head up tilt test. A total of 243 children (132 girls and 111 boys) were recruited from April 2007 to April 2013. The patients’ treatment outcomes were determined through telephone interviews. All the statistical analyses were performed using the SPSS statistical software (version 16.0). Besides, P < 0.05 was considered to be statistically significant.

Results: The majority of the patients were female (54.3% vs. 45.7%). In addition, the mean age at the first episode of syncope was 13.02 ± 3.9 years and 14.8% of the patients had positive family history of syncope. The mean duration of follow-up was 4.2 ± 3.41 years. Besides, breath holding spell history was positive in 13.6% of the patients. Medical treatment was done for 76.5% of the patients (96.7% propranolol and 3.3% atenolol). Increase of salt and fluid intake and physical maneuvers were performed for management of syncope in 75.3% and 30.9% of the patients, respectively. During follow-up, 66.7% of the patients did not experience any syncope episodes at all. Among the patients, 33.3% were referred by neurologists, while 66.7% had self-referred or referred by pediatricians or family practitioners. Moreover, 80.2%, 8.6%, and 6.2% of the syncope cases were mixed type, inodeppressive, and choronodeppressive, respectively. Furthermore, 35.8% of the tilt tests were positive with nitroglycerin consumption. Also, 11.1% of the patients had asystole > 3 seconds during syncope.

Conclusions: This study indicated that similar to other populations, syncope was more prevalent among girls in our area. Additionally, the most common cause was mixed type of vasovagal syncope. Medical therapy along with offering the patients to increase water and salt intake and do counter pressure physical maneuvers were effective in reduction of the recurrence of syncope.