Gülçin BOZLU, Fatma DURAK, Derya DUMAN, Derya KARPUZ, Mustafa KÖMÜR, Olgu HALİLOĞLU

Çocuk acil servise senkop nedeniyle getirilen 1020 olgunun geriye dönük değerlendirilmesi

Amaç: Senkop basit fizyolojik değişikliklerden, yaşamı tehdit eden ciddi hastalıklara kadar pek çok nedene bağlı olarak gelişebilen, postür ve tonus kaybıyla giden kısa süreli geçici bir bilinç kaybıdır. Bu çalışmada senkop nedeniyle çocuk acile getirilen olgularda, tanısal amaçlı yapılan testler ve sonuçları değerlendirildi. Yöntem: Çalışmaya Ekim 2012-Ekim 2017 tarihleri arasında Mersin Üniversitesi Tıp Fakültesi Çocuk Acil Servisi’ne, senkop nedeniyle getirilen, 1-18 yaş arasındaki 1020 olgu dahil edildi. Hastaların demografik ve klinik özellikleri, elektrokardiyografi kayıtları, tam kan sayımı, serum elektrolitleri, ekokardiyografi, beyin manyetik rezonans ve/veya bilgisayarlı tomografi görüntülemesi, elektroensefalografi ve 24 saatlik Holter elektrokardiyografi ritim analizi testleri dosya kayıtlarından geriye dönük olarak incelendi. Bulgular: Çalışmaya alınan hastaların 416’sı (%40.78) erkek, 604’ü (%59.21) kız hasta olup yaş ortalaması 12.82±4.88 yıl idi. Olguların 365’i (%35.78) bir, 566’sı (%55.49) iki, 75’i (%7.34) üç ve 14’ü (%1.37) üçün üzerinde senkop atağı geçirmişti. Hastaların hepsine elektrokardiyografi, 566’sına (%55.49) ekokardiyografi, 128'ine (%12.54) beyin manyetik rezonans görüntüleme, 214'üne (%20.98) beyin bilgisayarlı tomografi, 307'sine (%30.09) elektroensefalografi ve 158'ine (%15.49) 24 saatlik holter elektrokardiyografi analizi yapılmıştı. En sık görüleni refleks/nöral aracılı senkoplardı (n=561, %55.0). Sonuç: Çocukluk çağında görülen senkoplar, genellikle masum patolojiler olmasına karşın, nadir de olsa altta yatan ciddi kardiyak, nörolojik veya metabolik problemlerin bir bulgusu olarak da karşımıza çıkabilirler. Senkopla başvuran tüm çocuk hastalarda gereksiz ileri incelemelerin önüne geçilebilmesi için ayrıntılı öykü ile tam bir sistemik muayene ve elektrokardiyografi yapılması önem taşımaktadır.

Anahtar Kelimeler:

Çocuk, Çocuk Acil Servis, , Senkop, Epilepsi

Retrospective analysis of 1020 pediatric cases with syncope who referred to pediatric emergency department

Introduction: Syncope is transient loss of conscious due to cerebral hypoperfusion, characterized by a rapid onset, short duration with loss of posture and tonus in which etiology varies from benign to serious health problems. In this study diagnostic tests and results had been evaluated in children with syncope who referred to emergency department. Methods: Between 1 October 2012 and 1 October 2017,the demographic findings and results of cardiac and neurophysiological tests of 1020 patients (age range 1-18 years) were retrospectively analysed. Demographic and clinical characteristics, electrocardiography recordings, complete blood count, serum electrolytes, echocardiography, brain magnetic resonance and / or computed tomography imaging, electroencephalography and 24-hour Holter electrocardiography rhythm analysis tests were retrospectively reviewed. Results: 416 patients (40.78%) were male and 604 of them (59.21%) were female. The mean age was 12.82±4.88 years. There was only one syncope attack in 365 cases (35.78%); the rest had more than one. Electrocardiography was performed in all patients. Echocardiography had been performed in 566 cases (55.49%);brain magnetic rezonans imaging in 128 patients (12.54%), brain computed tomography in 214 patients (20,98%); electroencephalograph in 307 patients(30.09%) and 24 hour holter electrocardiography monitoring in 158 patients (15.49%). The most common was reflex / neural mediated syncope (n=561, 55.0%). Conclusion: Although syncope seen in childhood is usually innocent pathologies, it may also present as a sign of underlying serious cardiac, neurological or metabolic problems. To prevent unnecessary further examination, detailed history with good physical examination and electrocardiography should be needed in all pediatric patients with syncope.

Keywords:

Children, pediatric emergency service, epilepsy, syncope,

PDF

___

Referans1. Kapoor WN. Syncope N Engl J Med 2000; 1856: 343.
Referans2. Lewis DA, Dhala A. Syncope in the pediatric patient. Pediatr Clin North Am 1999;46(2):205-219.
Referans3. Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Thomsen PEB et al. Guidelines on management (diagnosis and treatment) of syncope. Task Force on Syncope European Society of Cardiology. EurHeart J 2001;22(15):1256-1306.
Referans4. Guidelines for the diagnosis and management of syncope (2009/2018). The Task Force for the diagnosis and management of Syncope of the European Society of Cardiology (ESC). European Heart Journal November 2009;30(21):2631-71.doi:10.1093/eurheartj/ehp298.
Referans5. Alehan F, Alehan A. Çocukluk çağında görülen senkoplar. Türk Klinikleri Pediatri Özel 2003;1(3):240-246.
Referans6. Massin MM, Bourguignont A, Coremans C, et al. Syncope in pediatric patients presenting to an emergency department. J Pediatr 2004; 145:223.
Referans7. DiMario FJ, Castillo CSW. Clinical categorization of childhood syncope. J Child Neurol 2011;26(5):548-551.
Referans8. Ünver Olcay, Kibar A. Esin, Erdem Sevcan, Ünver Afşin, Çakır Esra Deniz Papatya. Syncope in Childhood: Retrospective Analysis of 121 Cases, J Clin Anal Med 2015;6(4): 432-435.
Referans9. Lerman Sagie T, Lerman P, Mukamel M, Blieden L, Mimouni M. A prospective evaluation of pediatric patients with syncope. Clin Pediatr 1994;33(2):66-70.Referans10. Parry SW, Kenny RA. The management of vasovagal syncope. QJM 1999; 92: 697- 705.
Referans11. Tatlı B, Aydınlı N, Çalışkan M, Özmen M. Non epileptik paroksizmal olaylar: olgu sunumları ile derleme. Türk Pediatri Arşivi 2004;39:58-64.
Referans12. Paris Y, Toro-Salazar OH, Gauthier NS, et al. Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology. J AmHeartAssoc 2016; 5.
Referans13. Mehmet Alper İkiz, İbrahim İlker Çetin, Filiz Ekici, Alev Güven, Aydan Değerliyurt, Gülsen Köse. Pediatric Syncope, Is Detailed Medical History the Key Point for Differential Diagnosis? Pediatric Emergency Care. May 2014; 30(5):331-334.
Referans14. P Uldall, J Alving, L K Hansen, M Kibaek, J Buchholt. The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal events. ArchDis Child 2006;91:219–221.
Referans15. Yakup ERGÜL, Kemal Nişli, Erkin Rahimov, Elif Erdem Özcan , Ümrah Aydoğan, Rukiye Eker Ömeroğlu, Aygün Dindar. Nörokardiyojenik Senkoplu Çocuk ve Adölesanlarda Tanı, Tedavi ve İzlem Sonuçlarının Değerlendirilmesi.J Child 2010; 10(4):190-197.
Referans16. Jeffrey B. Anderson, Martha Willis, Heidi Lancaster, Karen Leonard, Cameron Thomas. The Evaluation and Management of Pediatric Syncope. Pediatr Neurol. 2016 Feb;55:6-13. Referans17. Sheldon R, Rose S, Connolly S, Ritchie D, Koshman ML, Frenneaux M. Diagnostic criteria for vasovagal syncope based on a quantitative history. EurHeart J 2006;27:344–350.
Referans18. Abubakr A, Wambacq I. The diagnostic value of EEGs in patients with syncope. Epilepsy Behav 2005 May;6(3):433-444.
Referans19. The Availability and the Adherence to Pediatric Guidelines for the magement of Syncope in the Emergency Department (J Pediatr 2014;165:967-972).
Referans20. ManZhang Q, Du J, Wang C, Du Z, Wang L, Tang C. The diagnostic protocol in children and adolescents with syncope: a multi-centre prospective study. Acta Pediatr 2009;98:879-884.
Referans21. Chen L, Zhang Q, Ingrid S, Chen J, Qin J, Du J. Aetiologic and clinical characteristics of syncope in Chinese children. ActaPaediatr 2007;96:1505–1510.
Referans22. Geggel RL. Conditions leading to pediatric cardiology consultation in a tertiary academic hospital. Pediatrics 2004;114:e409-417.
Referans23. Barbeito-Caamaño C1, Sánchez-Fernández G1, Bouzas-Mosquera A2, Broullón FJ3, Álvarez-García N1, Vázquez-Rodríguez JM. MedClin (Barc).Diagnostic and prognostic efficiency of 24-hour Holter monitoring in patients with syncope. 2016 Aug 19;147(4):148-50.
Referans24. Gillette PC, Garson A Jr. Sudden cardiac death in the pediatric population. Circulation 1992; 85:I64.
Referans25. Margaret J. Strieper, DO. Distinguishing Benign Syncope from Life-Threatening Cardiac Causes of Syncope.Semin Pediatr Neurol. March 2005, 12(1): Pages 32-38.
Referans26. Ritter S, Tani LY, Etheridge SP, et al. What is the yield of screening echocardiography in pediatric syncope? Pediatrics 2000; 105:E58.
Referans27. Connor Redd1,3 • Cameron Thomas2,3 • Martha Willis1,3 • Michelle Amos1,3 • Jeffrey Anderson1,3. Cost of Unnecessary Testing in the Evaluation of Pediatric Syncope. Pediatr Cardiol (2017) 38:1115–1122.
Referans28. Uldall, J Alving, L K Hansen, M Kibæk, J Buchholt. The misdiagnosis of epilepsy in children admitted to a tertiary epilepsy centre with paroxysmal events. ArchDis Child 2006;91:219–221.