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      Utilidad del Tilt test en el diagnostico de sincope en pediatria: experiencia de 345 casos Translated title: Head-up tilt table test in pediatrics syncope diagnose: 345 cases report

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          Abstract

          El síncope es la pérdida transitoria del estado de conciencia y del tono postural, representa alrededor de 2-5% de todas las consultas de emergencias. Los pacientes pediátricos, al momento de su evaluación, suelen encontrarse asintomàticos, el diagnóstico se fundamenta en la obtención de un correcto interrogatorio y un minucioso examen clínico. El TILT TEST (TT) puede ser un método efectivo para obtener un diagnóstico etiológico en pacientes con síncope de origen vasovagal (SVV) y en aquellos pacientes en quienes se plantea diagnóstico diferencial de epilepsia y que reciben tratamiento anticonvulsivante. Objetivo: Categorizar los resultados de los TT realizados en pacientes pediátricos, evaluados en la consulta de cardiología entre enero 2013 - enero 2015. Métodos: Estudio retrospectivo y descriptivo de 345 pacientes referidos para realizar TT con sospecha diagnóstica de síncope. Resultados: El sexo predominante fue el femenino (59,7%), el grupo etario predominante: niños de 2-9 años (n: 196; 56,8 %), el restante fueron adolescentes. El TT fue positivo en 183 pacientes (53,04%) para diagnóstico de síncope, aumentó a 76,2 % anexando otras formas de disautonomía, el síncope más frecuente fue el vasodepresor (59 %), con predominio estadísticamente significativo (Z = 3,35; p < 0,001), seguido del sincope mixto. Discusión: El síncope es un motivo de consulta frecuente en pediatría y causa de preocupación para los padres; los resultados coinciden con la literatura, siendo el síncope vasodepresor el más frecuente. Conclusiones: El TT es una herramienta útil para diagnosticar síncope y otros tipos de disautonomía, sobre todo en pacientes que reciben tratamiento anticonvulsivante con sospecha de síncope.

          Translated abstract

          Syncope is defined as complete transient loss of conscious with complete and spontaneous recovery, is a frequent disease, represents 2- 5 % total emergency visits. Most pediatric patients´ evaluation is completely normal, that makes interrogation and clinical examination crucial for diagnose. Head up Tilt test (HUTT) is a valuable diagnose tool in vasovagal or neurally mediated syncope especially in patients who have epilepsy and are receiving seizure treatment. Objective: Head up Tilt test results are described and categorized in patients evaluated in cardiology or referred by another pediatric cardiologist to perform HUTT from january 2013 to january 2015. Methods: Retrospective, descriptive study in 345 children in whom HUTT was performed. Results: Predominant sex was Female 59.7%, the predominant age group includes children 2-9 years (196 ) represents 56.8%, the remainder were adolescents. HUTT was positive for syncope in 183 patients (53.04 %) and increase to 76.2 % if other diasutonomic disorders are added. Vasodepresor syncope was the most frequent (59 %) with statistically significant predominance, followed by mix response. Discussion: Syncope is a frequent medical atenndance cause and it causes parents anxiety. Our results are similar to other authors being vasodepresor syncope the most frequent. Conclusions: HUTT is a valuable tool for syncope diagnose especially in patients who are receiving seizures treatment.

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          Most cited references24

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          Neurocardiogenic syncope and related disorders of orthostatic intolerance.

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            Syncope

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              Risk factors for syncope in a community-based sample (the Framingham Heart Study).

              The epidemiology of syncope has not been well described. Prior studies have examined risk factors for syncope in hospital-based or other acute or long-term care settings. To determine risk factors for syncope in a community-based sample, we performed a nested case-control study. We examined reports of syncope in Framingham Heart Study participants who underwent routine clinic visits from 1971 to 1990. For each syncope case (n = 543) 2 controls were matched for age, sex, and examination period. Mean age of subjects was 67 years (range 25 to 95); 59% were women. History of stroke or transient ischemic attack, history of myocardial infarction, high blood pressure, use of antihypertensive medication, use of other cardiac medication, smoking, alcohol intake, body mass index, systolic blood pressure, diastolic blood pressure, heart rate, atrial fibrillation, PR interval prolongation, interventricular block, and diabetes or elevated glucose level were examined as potential predictors. Using conditional logistic regression analysis, the predictors of syncope included a history of stroke or transient ischemic attack (odds ratio [OR] 2.56, 95% confidence interval [CI] 1.62 to 4.04), use of cardiac medication (OR 1.67, 95% CI 1.21 to 2. 30), and high blood pressure (OR 1.46, 95% CI 1.14 to 1.88). Lower body mass index was marginally associated with syncope (OR per 4 kg/m(2) decrement 1.10, 95% CI 0.99 to 1.22), as were increased alcohol intake (OR per 5 oz/week 1.11, 95% CI 0.99 to 1.26), and diabetes or an elevated glucose level (OR 1.29, 95% CI 0.96 to 1.75). To our knowledge, this study represents the first community-based study of risk factors for syncope.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                avpp
                Archivos Venezolanos de Puericultura y Pediatría
                Arch Venez Puer Ped
                Sociedad Venezolana de Puericultura y Pediatría
                0004-0649
                September 2015
                : 78
                : 3
                : 79-81
                Affiliations
                [1 ] Clínica La Viña
                [2 ] Clínica La Viña
                [3 ] Universidad de Carabobo
                [4 ] Clínica La Viña
                [5 ] Hospital Universitario Angel Larralde
                Article
                S0004-06492015000700003
                7624c14a-67f4-4057-88ec-df818860a779

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0004-0649&lng=en
                Categories
                HEALTH CARE SCIENCES & SERVICES
                HEALTH POLICY & SERVICES
                PEDIATRICS

                Pediatrics,Health & Social care,Public health
                Síncope,Syncope,Tilt Test,Vasodepresor Syncope,children,adolescents,Síncope Vasodepresor,Niños, Adolescentes

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