The Availability and the Adherence to Pediatric Guidelines for the Management of Syncope in the Emergency Department
Abstract
Objective To evaluate the impact of the 2009 Italian pediatric clinical guidelines on the management of syncope. Study design A retrospective study of patients who presented to the Emergency Department (ED) of Bambino Gesù Children's Hospital with syncope during the 2 years before and then for 2 years after the establishment of the Italian pediatric clinical guidelines. Implementation of the clinical guidelines included educational seminars, additional training of health care workers, and the availability of clinical guidelines and its algorithms on ED examination rooms. Results We studied a population of 1073 patients (n = 470 vs n = 603). Most patients had neurocardiogenic syncope with a greater increase in postimplementation period (n = 241, 51.3% vs n = 454, 49.8%); we also noticed a parallel reduction of the number of patients with undefined syncope (30% vs 8.3%). We observed an increase in electrocardiogram (n = 328, 69.8% vs n = 512, 85.1%; P Conclusions Providing practitioners in the ED with age-oriented clinical guidelines increased the efficiency of clinical management of pediatric syncope. Our study demonstrated that the implementation of pediatric clinical guidelines on syncope improve diagnosis, reduce hospital admissions, and decrease the use of unnecessary diagnostic tests.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Decision support algorithms may reduce health service use in the evaluation of syncope.
“Decision support algorithms may reduce health service use in the evaluation of syncope (Figures 1 and 2) (105,111–113), although there are currently insufficient data to advocate the use of specific decision support algorithms for making disposition decisions.”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [112]
Cites
Why Don't Physicians Follow Clinical Practice Guidelines?: A Framework for Improvement
Cabana, M. D., Rand, C. S., Powe, N. R., Wu, A. W., Wilson, M. H., Abboud, P.-A. C., & Rubin, H. R. (1999) · JAMA · doi:10.1001/jama.282.15.1458 · Cited by 6,677 · see citing works
Pearce, M. S., Salotti, J. A., Little, M. P., McHugh, K., Lee, C., Kim, K. P., Howe, N. L., Ronckers, C. M., Rajaraman, P., Craft, A. W., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60815-0 · Cited by 3,735 · see citing works
Developed in collaboration with, European Heart Rhythm Association (EHRA), Heart Failure Association (HFA), and Heart Rhythm Society (HRS), societies, E. B. T. F., European Society of Emergency Medicine (EuSEM), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), American Geriatrics Society (AGS), European Neurological Society (ENS), et al. (2009) · European Heart Journal · doi:10.1093/eurheartj/ehp298 · Cited by 2,040 · see citing works
Projected Cancer Risks From Computed Tomographic Scans Performed in the United States in 2007
de González, A. B. (2009) · Archives of Internal Medicine · doi:10.1001/archinternmed.2009.440 · Cited by 1,891 · see citing works
Guidelines on Management (diagnosis and treatment) of syncope ? update 2004
Brignole, M., Alboni, P., Benditt, D. G., Bergfeldt, L., Blanc, J., Thomsen, P. E. B., van Dijk, J. G., Fitzpatrick, A. P., Hohnloser, S. H., Janousek, J., et al. (2004) · EP Europace · doi:10.1016/j.eupc.2004.08.008 · Cited by 648 · see citing works
Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive Summary.
Brignole, M., Alboni, P., Benditt, D. G., Bergfeldt, L., Blanc, J., Thomsen, P. E. B., van Dijk, J. G., Fitzpatrick, A. P., Hohnloser, S. H., Janoušek, J., et al. (2004) · European Heart Journal · doi:10.1016/j.ehj.2004.09.004 · Cited by 562 · see citing works
AHA/ACCF Scientific Statement on the Evaluation of Syncope
Strickberger, S. A., Benson, D. W., Biaggioni, I., Callans, D. J., Cohen, M. I., Ellenbogen, K. A., Epstein, A. E., Friedman, P. A., Goldberger, J. J., Heidenreich, P. A., et al. (2006) · Circulation · doi:10.1161/circulationaha.105.170274 · Cited by 332 · see citing works
Direct medical costs of syncope-related hospitalizations in the United States
Sun, B. C., Emond, J. A., & Camargo, C. A. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2004.11.013 · Cited by 305 · see citing works
Syncope in Children and Adolescents
Driscoll, D. J., Jacobsen, S. J., Porter, C.-B. J., & Wollan, P. C. (1997) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(97)00020-x · Cited by 283 · see citing works
Guidelines on management (diagnosis and treatment) of syncope—update 2004
Brignole, M., Alboni, P., & Benditt, D. G. (2005) · ACC Current Journal Review · doi:10.1016/j.accreview.2005.02.024 · Cited by 189 · see citing works
Sudden death in children and adolescents
Wren, C., O’Sullivan, J., & Wright, C. (2000) · Heart · doi:10.1136/heart.83.4.410 · Cited by 186 · see citing works
Syncope in pediatric patients presenting to an emergency department
Massin, M. M., Bourguignont, A., Coremans, C., Comté, L., Lepage, P., & Gérard, P. (2004) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2004.01.048 · Cited by 156 · see citing works
Reflex syncope in children and adolescents
Wieling, W., Ganzeboom, K. S., & Saul, J. P. (2004) · Heart · doi:10.1136/hrt.2003.022996 · Cited by 155 · see citing works
Conditions Leading to Pediatric Cardiology Consultation in a Tertiary Academic Hospital
Geggel, R. L. (2004) · PEDIATRICS · doi:10.1542/peds.2003-0898-l · Cited by 146 · see citing works
SYNCOPE IN THE PEDIATRIC PATIENT
Lewis, D. A., & Dhala, A. (1999) · Pediatric Clinics of North America · doi:10.1016/s0031-3955(05)70113-9 · Cited by 143 · see citing works
Syncope in children: Diagnostic tests have a high cost and low yield
Steinberg, L. A., & Knilans, T. K. (2005) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2004.10.039 · Cited by 99 · see citing works
What Is the Yield of Screening Echocardiography in Pediatric Syncope?
Ritter, S., Tani, L. Y., Etheridge, S. P., Williams, R. V., Craig, J. E., & Minich, L. L. (2000) · PEDIATRICS · doi:10.1542/peds.105.5.e58 · Cited by 95 · see citing works
Impact of a Bronchiolitis Guideline on ED Resource Use and Cost: A Segmented Time-Series Analysis
Akenroye, A. T., Baskin, M. N., Samnaliev, M., & Stack, A. M. (2013) · PEDIATRICS · doi:10.1542/peds.2013-1991 · Cited by 90 · see citing works
McLeod, K. A. (2003) · Archives of Disease in Childhood · doi:10.1136/adc.88.4.350 · Cited by 79 · see citing works
The diagnostic protocol in children and adolescents with syncope: a multi‐centre prospective study
Zhang, Q., Du, J., Wang, C., Du, Z., Wang, L., & Tang, C. (2009) · Acta Paediatrica · doi:10.1111/j.1651-2227.2008.01195.x · Cited by 74 · see citing works
Sudden death in children and adolescents
Wren, C. (2002) · Heart · doi:10.1136/heart.88.4.426 · Cited by 73 · see citing works
Martineau, H. (2008) · Cited by 68 · see citing works
Chin, R. L., Browne, G., Lam, L. T.-M., McCaskill, M. E., Fasher, B., & Hort, J. (2002) · Journal of Paediatrics and Child Health · doi:10.1046/j.1440-1754.2002.00011.x · Cited by 63 · see citing works
Armon, K. (2004) · Archives of Disease in Childhood · doi:10.1136/adc.2002.024406 · Cited by 59 · see citing works
Clinical practice guidelines: barriers to durability after effective early implementation
Brand, C. A., Landgren, F., Hutchinson, A. F., Jones, C., MacGregor, L., & Campbell, D. A. (2005) · Internal Medicine Journal · doi:10.1111/j.1445-5994.2004.00763.x · Cited by 56 · see citing works
Cardiac Syncope in Pediatric Patients
MASSIN, M. M., Malekzadeh-Milani, S. G., & Benatar, A. A. (2007) · Clinical Cardiology · doi:10.1002/clc.28 · Cited by 50 · see citing works
Galanello, R., Campus, S., & Origa, R. (2007) · UNICA IRIS Institutional Research Information System (University of Cagliari) · Cited by 50 · see citing works
Myocardial Infarction in Healthy Adolescents
Lane, J. R., & Ben‐Shachar, G. (2007) · PEDIATRICS · doi:10.1542/peds.2006-3123 · Cited by 45 · see citing works
Pediatric Syncope: National Hospital Ambulatory Medical Care Survey Results
Anderson, J. B., Czosek, R. J., Cnota, J. F., Meganathan, K., Knilans, T. K., & Heaton, P. C. (2012) · Journal of Emergency Medicine · doi:10.1016/j.jemermed.2012.01.020 · Cited by 45 · see citing works
Syncope in the Pediatric Patient: Diagnosis, Pathophysiology, and Treatment
Feit, L. R. (1996) · Advances in Pediatrics · doi:10.1016/s0065-3101(24)00082-3 · Cited by 33 · see citing works
ED management of pediatric syncope: searching for a rationale
Goble, M. M., Benitez, C., Baumgardner, M., & Fenske, K. (2008) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2007.06.012 · Cited by 26 · see citing works
‘Evidence‐based implementation’ of paediatric asthma guidelines in a rural emergency department
Doherty, S., Jones, P. D., Stevens, H. E., Davis, L., Ryan, N. J., & Treeve, V. (2007) · Journal of Paediatrics and Child Health · doi:10.1111/j.1440-1754.2007.01151.x · Cited by 25 · see citing works
Implementation of a Febrile Seizure Guideline in Two Pediatric Emergency Departments
Callegaro, S., Titomanlio, L., Donegà, S., Tagliaferro, T., Andreola, B., Galli-Gibertini, G., Park, S. Y., Smail, A., Mercier, J., & Dalt, L. D. (2009) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2008.09.008 · Cited by 23 · see citing works
The cardiologist's perspective.
HEALY, B. P. (2008) · PubMed · Cited by 18 · see citing works
Transient loss of consciousness
O’Callaghan, P. (2012) · Medicine · doi:10.1016/j.mpmed.2012.05.010 · Cited by 16 · see citing works
McCanny, P., McCoy, S., Grant, T., Walsh, S., & O’Sullivan, R. (2012) · Emergency Medicine Journal · doi:10.1136/emermed-2011-200604 · Cited by 15 · see citing works
Flagged first, then by citations
1 of the 37 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 484 · see citing works
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000499 · Cited by 453 · see citing works
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000498 · Cited by 408 · see citing works
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327 · see citing works
Kenny, R. A., Brignole, M., Dan, G., Deharo, J., van Dijk, J. G., Doherty, C. P., Hamdan, M. H., Moya‐Mitjans, À., Parry, S. W., Sutton, R., et al. (2015) · EP Europace · doi:10.1093/europace/euv115 · Cited by 124 · see citing works
Reducing Unnecessary Imaging and Pathology Tests: A Systematic Review
Hiscock, H., Neely, R. J., Warren, H., Soon, J., & Georgiou, A. (2018) · PEDIATRICS · doi:10.1542/peds.2017-2862 · Cited by 50 · see citing works
Pediatric Syncope: A Systematic Review
Zavala, R. G., Metais, B., Tuckfield, L., DelVecchio, M., & Aronoff, S. C. (2020) · Pediatric Emergency Care · doi:10.1097/pec.0000000000002149 · Cited by 44 · see citing works
Sanatani, S., Chau, V., Fournier, A., Dixon, A., Blondin, R., & Sheldon, R. S. (2016) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2016.09.006 · Cited by 41 · see citing works
Vertigo/dizziness in pediatric emergency department: Five years’ experience
Raucci, U., Vanacore, N., Paolino, M. C., Silenzi, R., Mariani, R., Urbano, A., Reale, A., Villa, M. P., & Parisi, P. (2015) · Cephalalgia · doi:10.1177/0333102415606078 · Cited by 40 · see citing works
Self-citationÇocuk acil servise senkop nedeniyle getirilen 1020 olgunun geriye dönük değerlendirilmesi
Bozlu, G., DURAK, F., Duman, D., Karpuz, D., Kömür, M., & Hallıoğlu, O. (2020) · Mersin üniversitesi sağlık bilimleri dergisi/Mersin üniversitesi sağlık bilimleri dergisi · doi:10.26559/mersinsbd.631787 · Cited by 16 · see citing works
Synkopenabklärung bei Kindern und Jugendlichen – Handeln wir gemäß der aktuellen Leitlinie?
Landwehr, K., Meyer, S., Flotats‐Bastardas, M., & Poryo, M. (2021) · Wiener Medizinische Wochenschrift · doi:10.1007/s10354-020-00798-3 · Cited by 8 · see citing works
Interventions to reduce acute paediatric hospital admissions: a systematic review
Dick, F. D., MacRae, C., McFaul, C., Rasul, U., Wilson, P., & Turner, S. (2021) · Archives of Disease in Childhood · doi:10.1136/archdischild-2021-321884 · Cited by 7 · see citing works
Use of a Pediatric Syncope Unit Improves Diagnosis and Lowers Costs: A Hospital-Based Experience
Drago, F., Calvieri, C., Placidi, S., Righi, D., Paglia, S., Vecchio, E. D., Silvetti, M. S., Gimigliano, F., Mambro, C. D., Unolt, M., et al. (2018) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2018.05.032 · Cited by 5 · see citing works
Self-citationKörnyei, L., Szabó, A., Róth, G., Kardos, A., & Fogarasi, A. (2021) · European Journal of Pediatrics · doi:10.1007/s00431-020-03913-z · Cited by 4 · see citing works
Moore, S. S., & Watemberg, N. M. (2016) · Acta Paediatrica · doi:10.1111/apa.13498 · Cited by 4 · see citing works
Çocuklarda Vertigo; Ayırıcı Tanı
Akcan, F. A. (2018) · Turkish Journal of Pediatric Disease · doi:10.12956/tjpd.2018.356 · Cited by 3 · see citing works
Toward a Common Definition of Syncope in Children and Adults
van Dijk, J. G., Benditt, D. G., Fanciulli, A., Fedorowski, A., Olshansky, B., Raj, S. R., Stewart, J. M., & Sutton, R. (2020) · Pediatric Emergency Care · doi:10.1097/pec.0000000000002309 · Cited by 3 · see citing works
Long-term Effects of an Evidence-based Guideline for Emergency Management of Pediatric Syncope
Shanahan, K. H., Monuteaux, M. C., Brunson, D. C., Guse, S. E., Alexander, M. E., Porter, J. J., Neuman, M. I., & Fine, A. M. (2020) · Pediatric Quality and Safety · doi:10.1097/pq9.0000000000000361 · Cited by 3 · see citing works
Grasso, A., Poropat, F., Vodié, T. K., Ghirardo, S., & Barbi, E. (2022) · PubMed · doi:10.1097/pec.0000000000002242 · Cited by 2 · see citing works
Pediatric Syncope: Etiological Predictors and Utility of Diagnostic Testing
Anilkumar, A. C., & Shenk, M. E. R. (2020) · Journal of the International Child Neurology Association · doi:10.17724/jicna.2020.154
Geçici bilinç kaybıyla başvuran çocuk olguların retrospektif değerlendirilmesi
UYSAL, İ., & Keskin, M. (2022) · Mustafa Kemal Üniversitesi Tıp Dergisi · doi:10.17944/mkutfd.992966
Pediatric Syncope: Is the Diagnostic Guideline Implemented and Adhered to?
Gatamova, D., Kieß, W., Dalla‐Pozza, R., & Merkenschlager, A. (2024) · Klinische Pädiatrie · doi:10.1055/a-2345-3343
- Authors
- Raucci, U., Scateni, S., Tozzi, A. E., Drago, F., Giordano, U., Marcias, M., Faa, F., & Reale, A.
- Affiliations
- Bambino Gesù Children's Hospital (IT)
- Corresponding author
- Raucci, Umberto
- Venue
- The Journal of Pediatrics
- Publisher
- Elsevier BV
- Published
- 2014-11
- Volume
- 165
- Issue
- 5
- Pages
- 967-972.e1
- ISSN
- 0022-3476 (ISSN-L)
- OpenAlex
- W2039014632
- Cited by
- 24
- References
- 37
- Citations by year
- 2024: 1 · 2022: 2 · 2021: 3 · 2020: 6 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 2
- FWCI
- 2.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- pediatric syncope, guideline implementation, vasovagal syncope, emergency department management, diagnostic testing utilization, hospitalization reduction, unnecessary testing, guideline adherence
- MeSH terms
- Adolescent, Child, Child, Preschool, Emergency Service, Hospital, Female, Hospitalization, Humans, Infant, Italy, Male, Retrospective Studies, Syncope, Practice Guidelines as Topic, Diagnostic Techniques and Procedures, Guideline Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
