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      Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

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          Abstract

          Background

          Pediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans ( SCAMPs).

          Methods and Results

          Ambulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5‐year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise‐related or more problematic symptoms. Guideline‐defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow‐up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach.

          Conclusions

          SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low‐severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention.

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          Most cited references26

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          Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome.

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            2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope.

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              Prevalence and triggers of syncope in medical students.

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                Author and article information

                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                19 February 2016
                February 2016
                : 5
                : 2 ( doiID: 10.1002/jah3.2016.5.issue-2 )
                : e002931
                Affiliations
                [ 1 ] Division of Pediatric CardiologyBaystate Medical Center Springfield MA
                [ 2 ] Department of PediatricsTufts Medical School Boston MA
                [ 3 ] Pediatric CardiologyConnecticut Children's Medical Center Hartford CT
                [ 4 ] Department of PediatricsUniversity of Connecticut School of Medicine Farmington CT
                [ 5 ] Pediatric CardiologyChildren's Hospital at Dartmouth‐Hitchcock Dover NH
                [ 6 ] Department of PediatricsGeisel School of Medicine at Dartmouth Hanover NH
                [ 7 ] Pediatric CardiologyHasbro Children's Hospital Providence RI
                [ 8 ] Department of PediatricsWarren Alpert Medical School at Brown University Providence RI
                [ 9 ] Pediatric CardiologyHarvard Vanguard Medical Associates Boston MA
                [ 10 ]Institute for Relevant Clinical Data Analytics, Inc Boston MA
                [ 11 ] Pediatric CardiologyChildren's Hospital of Wisconsin Milwaukee WI
                [ 12 ] Department of PediatricsMedical College of Wisconsin Milwaukee WI
                [ 13 ] Department of CardiologyBoston Children's Hospital Boston MA
                [ 14 ] Arrhythmia ServiceBoston Children's Hospital Boston MA
                [ 15 ] Department of PediatricsHarvard Medical School Boston MA
                Author notes
                [*] [* ] Correspondence to: Mark E. Alexander, MD, Department of Cardiology, Boston Children's Hospital, Boston, MA 02115. E‐mail: mark.alexander@ 123456cardio.chboston.org
                [†]

                Accompanying Appendices S1, S2 and list of additional participants in the New England Congenital Cardiology Association (NECCA) are available at http://jaha.ahajournals.org/content/5/2/e002931/suppl/DC1

                Article
                JAH31345
                10.1161/JAHA.115.002931
                4802448
                26896480
                fcdbf446-f415-4cc8-9088-0e7bf35d4ecd
                © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 12 November 2015
                : 21 December 2015
                Page count
                Pages: 13
                Funding
                Funded by: Boston Children's Heart Foundation
                Funded by: Institute for Relevant Clinical Data Analytics
                Funded by: Tommy Kaplan Fund
                Funded by: New England Congenital Cardiology Research Foundation (NECCRF)
                Categories
                Original Research
                Original Research
                Pediatric Cardiology
                Custom metadata
                2.0
                jah31345
                February 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.8.4 mode:remove_FC converted:03.03.2016

                Cardiovascular Medicine
                adolescence,ambulatory care,pediatrics,syncope (fainting),health services,diagnostic testing

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