The Clinical Characteristics and the Usefulness of the Ocular Compression Test in Syncope of Children Test

Kim, Ki Sung; Lee, Eun Byul; Chung, Hee Jung

Abstract

PURPOSE
Nevertheless that syncope of children is a relatively common disease which occurs during adolescence, diagnostic yield rate of syncope of children is far below than that of adults. Some reports indicate that the diagnostic rate could be increased up to 70% by using the head-up tilt test(HUT). However, HUT is relatively invasive and harmful to be used for children. The purpose of this study is to analyze the etiology of syncope in children and investigate whether the ocular compression test(OCT), which is not invasive and relatively safe, could substitute the HUT for vasovagal syncope.
METHODS
Children who visited NHIC Ilsan Hospital for syncope from January 2004 to July 2006 were retrospectively analyzed. We examined the medical records of the patients and performed the basic diagnostic tests including EEG as well as HUT. OCT was performed during EEG to find check out the presence and the duration of asystole. We classified the patients into 3 groups according to the etiology, such as neurally-mediated(vasovagal), cardiovascular and non- cardiovascular syncopes and comparatively analyzed the clinical characteristics of each group. In addition, in case the asystole duration of OCT is prolonged, we performed cross-table analysis to know whether it matches the positive result of HUT in order to confirm the availability of OCT.
RESULTS
55 patients were included in the study and the rate of males to female was 1: 2.4. The causes of syncope were identified in 43 cases(78.2%) and half of which was neurally- mediated type. In detail, 24(43.6%) patients were neurally-mediated, 5(9.1%) were cardiovascular, 14(25.5%) non-cardiovascular and 12(21.8%) unidentified. There was no significant difference regarding the clinical characteristics among diagnostic groups. However, the neurally- mediated syncope group showed statistically significant difference in the duration of asystole. Therefore, when we make a point over 3 seconds of asystole in OCT, it will produce the most similar result with the HUT in neurally-mediated(vasovagal) syncope(specificity 94.4%).
CONCLUSION
Generally, syncope in children peaks during adolescence and it is more common among girls than boys. The etiologic diagnostic rate was 78.2% and the neurally-mediated syncope was the most common type. The cardiovascular syncope of children was much less in contrast to that of adults. There was no statistically significant difference in the clinical characteristics among the three diagnostic groups. It is concluded that OCT, a non-invasive and relatively safe test, could substitute the invasive, and harmful HUT for vasovagal syncope of children.