A framework to simplify paediatric syncope diagnosis.
A framework to simplify paediatric syncope diagnosis.
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DOI：
10.1007/s00431-023-05114-w
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发表时间：
2023-11
影响因子：
3.6
通讯作者：
Sutton, Richard
中科院分区：
文献类型：
--
作者：
Stewart, Julian M.;van Dijk, J. Gert;Balaji, Seshadri;Sutton, Richard
本文旨在提高对小儿晕厥和短暂性意识丧失的诊断水平。诊断问题首先源于跨越不同学科的一些原因，例如心脏病学、神经病学和精神病学，而最常见的原因血管迷走神经性晕厥不属于任何专业。其次，临床变异性很大，体征和症状重叠。第三，欧洲心脏病学会（ESC）的Tynecology/晕厥方法在儿童保育中未得到充分利用。我们使用额外的儿科文献综述来解释ESC指南。晕厥和眩晕的分类是分层的，并以病史为基础。意识丧失（Loss of Consciousness，缩写为LSE）有三个特征：运动控制异常，包括跌倒、反应能力下降和健忘。加上< 5分钟的持续时间和自发恢复定义了Tcirrhosis。TVT通过排除长期发作（例如，一些创伤、中毒和低血糖）并专注于晕厥、强直阵挛性癫痫发作和功能性TVT来简化诊断。晕厥，即由于脑灌注不足引起的晕厥，分为反射性晕厥（主要是血管迷走性）、直立性低血压（主要是青少年的初始直立性低血压）和心源性晕厥（心律失常和结构性心脏疾病）。初步调查包括询问病史、体格检查和心电图;直立位血压测量在儿童中的价值未经证实，但可能较低。当这不能产生诊断时，评估心脏危险因素;重要的线索是仰卧晕厥，运动时晕厥，亲属的早期死亡和心电图异常。 结论：在成人中，ESC指南的应用减少了缺席诊断和费用的数量;我们希望这也适用于儿童。
This paper aims to improve the diagnosis of syncope and transient loss of consciousness (TLOC) in children. Diagnostic problems stem, first, from some causes spanning various disciplines, e.g. cardiology, neurology and psychiatry, while the most common cause, vasovagal syncope, is not embraced by any specialty. Second, clinical variability is huge with overlapping signs and symptoms. Third, the approach to TLOC/syncope of the European Society of Cardiology (ESC) is underused in childcare. We explain the ESC guidelines using an additional paediatric literature review. Classification of TLOC and syncope is hierarchic and based on history taking. Loss of consciousness (LOC) is defined using three features: abnormal motor control including falling, reduced responsiveness and amnesia. Adding a < 5 min duration and spontaneous recovery defines TLOC. TLOC simplifies diagnosis by excluding long LOC (e.g. some trauma, intoxications and hypoglycaemia) and focussing on syncope, tonic–clonic seizures and functional TLOC. Syncope, i.e. TLOC due to cerebral hypoperfusion, is divided into reflex syncope (mostly vasovagal), orthostatic hypotension (mostly initial orthostatic hypotension in adolescents) and cardiac syncope (arrhythmias and structural cardiac disorders). The initial investigation comprises history taking, physical examination and ECG; the value of orthostatic blood pressure measurement is unproven in children but probably low. When this fails to yield a diagnosis, cardiac risk factors are assessed; important clues are supine syncope, syncope during exercise, early death in relatives and ECG abnormalities. Conclusions: In adults, the application of the ESC guidelines reduced the number of absent diagnoses and costs; we hope this also holds for children.
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