Syncope is a common problem in children presenting to emergency departments. Before adolescence, about 15 percent of children have at least one episode of sudden transient loss of consciousness with spontaneous recovery. The cause usually is benign but may reflect significant cardiac, neurologic, or metabolic pathology.

Massin and associates evaluated the medical records of a series of children presenting to an emergency department with syncope beginning in 1998. Participants were followed passively through their medical records until the summer of 2003 to identify further information that may have been related to the initial syncopal episode.

Among the 226 patients who had 252 presentations to the emergency department for syncope, 144 were discharged directly, and 82 were admitted to the hospital. Neurocardiogenic syncope was the most common diagnosis (181 patients), with neurologic problems (most frequently, convulsive disorder) being identified in 21 patients. Cardiac problems were identified in five patients; in the remaining patients, psychogenic problems, breath-holding spells, or intoxication through poisoning or drug overdose was determined to be the cause of syncope, with isolated cases of obstructive respiratory disease, hypoglycemia, and aplastic crisis. Recurrence was associated with psychogenic and cardiac causes. Physical examinations were normal in 218 children, although cardiovascular and neurologic findings were useful in a small group of patients.

The authors conclude that a careful history focusing on events leading up to the syncopal episode and a complete physical examination seem to direct the choice of appropriate diagnostic testing (see accompanying figure). If the initial work-up does not reveal the diagnosis, close follow-up may clarify it. Psychiatric disorders should be considered in children with neurocardiogenic syncope.