Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-28T01:59:12.327Z Has data issue: false hasContentIssue false

Modified Calgary score in differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope in children

Published online by Cambridge University Press:  09 October 2012

Jinyan Yang
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Lulu Zhu
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Stella Chen
Affiliation:
Department of Biological Sciences, University of California, San Diego, La Jolla, CA, United States
Xueying Li
Affiliation:
Department of Medical Statistics, Peking University First Hospital, Beijing, China
Qingyou Zhang
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Fengwen Zhang
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Li Chen
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Chaoshu Tang
Affiliation:
Department of Physiology and Pathophysiology, Peking University Health Science Centre, Beijing, China Key Laboratory of Molecular Cardiology, Ministry of Education, Beijing, China
Junbao Du
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
Hongfang Jin*
Affiliation:
Department of Pediatrics, Peking University First Hospital, Beijing, China
*
Correspondence to: Prof. H. Jin, Department of Pediatrics, Peking University First Hospital, Beijing 100034, P. R. China. Tel: +8610 83573209; Fax: +8610 66530532; E-mail: jinhongfang51@126.com

Abstract

The present study was designed to analyse the usefulness of a modified Calgary score system during differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope through a large sample sized clinical investigation. The study included 213 children, including 101 boys and 112 girls, with cardiac syncope or postural orthostatic tachycardia syndrome-associated syncope in the age group of 2–19 years (mean 11.8 ± 2.9 years). A modified Calgary score was created, which was analysed to predict differential diagnoses between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope using a receiver operating characteristic curve. The median of modified Calgary scores for cardiac syncope was −5.0, which significantly differed from that of postural orthostatic tachycardia syndrome (0.0; p < 0.01). The sensitivity and specificity of a differentiation score of less than −2.5 was 96.3% and 72.7%, respectively. Owing to the fact that the modified Calgary score was an integer, when less than −3.0 the diagnosis could be considered as cardiac syncope. The modified Calgary score could be used to make an initial differential diagnosis between cardiac syncope and postural orthostatic tachycardia syndrome-associated syncope in the clinic.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Chen, L, Zhang, QY, Ingrid, S, Chen, JJ, Qin, J, Du, JB. Aetiologic and clinical characteristics of syncope in Chinese children. Acta Paediatr 2007; 96: 15051510.CrossRefGoogle ScholarPubMed
2. Kapoor, WN, Smith, MA, Miller, NL. Upright tilt testing in evaluating syncope: a comprehensive literature review. Am J Med 1994; 97: 7888.CrossRefGoogle ScholarPubMed
3. Benditt, DG, Remole, S, Bailin, S, Dunnigan, A, Asso, A, Milstein, S. Tilt table testing for evaluation of neurally-mediated (cardioneurogenic) syncope: rationale and proposed protocols. Pacing Clin Electrophysiol 1991; 14: 15281537.CrossRefGoogle ScholarPubMed
4. Abboud, FM. Neurocardiogenic syncope. N Engl J Med 1993; 328: 11171120.CrossRefGoogle ScholarPubMed
5. Chen, L, Du, JB. Children orthostatic intolerance. Chin J Med 2006; 41: 2123.CrossRefGoogle Scholar
6. Ojha, A, Chelimsky, TC, Chelimsky, G. Comorbidities in pediatric patients with postural orthostatic tachycardia syndrome. J Pediatr 2011; 158: 2023.CrossRefGoogle ScholarPubMed
7. Stewart, JM. Postural tachycardia syndrome and reflex syncope: similarities and differences. J Pediatr 2009; 154: 481485.CrossRefGoogle ScholarPubMed
8. MacCormick, JM, Crawford, JR, Chung, SK, et al. Symptoms and signs associated with syncope in young people with primary cardiac arrhythmias. Heart Lung Circ 2011; 20: 593598.CrossRefGoogle ScholarPubMed
9. The Subspecialty Group of Cardiology, The Society of Pediatrics, Chinese Medical Association and The Editorial Board, Chinese Journal of Pediatrics. Guidelines for diagnosis of syncope in children. Chin J Pediatr, 2009; 47: 99–101.Google Scholar
10. Serletis, A, Sheldon, RS. Neurally-mediated reflex syncope: recognition by history and clinical testing. In: Benditt DG, Brignole M, Raviele A, Wieling W (eds.). Syncope and Transient Loss of Consciousness: Multidisciplinary Management. Blackwell Publishing, San Francisco, 2007, pp 4450.CrossRefGoogle Scholar
11. Sheldon, R, Rose, S, Connolly, S, Ritchie, D, Koshman, ML, Frenneaux, M. Diagnostic criteria for vasovagal syncope based on a quantitative history. Eur Heart J 2006; 3: 344350.CrossRefGoogle Scholar
12. Romme, JJ, van Dijk, N, Boer, KR, Bossuyt, PM, Wieling, W, Reitsma, JB. Diagnosing vasovagal syncope based on quantitative history-taking: validation of the Calgary Syncope Symptom Score. Eur Heart J 2009; 30: 28882896.CrossRefGoogle ScholarPubMed
13. Low, PA, Sandroni, P, Joyner, M, Shen, WK. Postural tachycardia syndrome. J Cardiovasc Electrophysiol 2009; 20: 352358.CrossRefGoogle ScholarPubMed
14. Saksena, S, Camm, AJ, Boyden, PA, et al. Electrophysiological Disorders of the Heart. Elsevier Limited, Amsterdam, 2005, pp 511523.Google Scholar
15. Sheldon, R, Rose, S, Connolly, S, Ritchie, D, Koshman, ML, Frenneaux, M. Diagnostic criteria for vasovagal syncope based on a quantitative history. Eur Heart J 2006; 3: 344350.CrossRefGoogle Scholar
16. Swets, JA. Measuring the accuracy of diagnostic systems. Science 1988; 240: 12851293.CrossRefGoogle ScholarPubMed
17. Stewart, JM, Gewitz, MH, Weldon, A, et al. Patterns of orthostatic intolerance: the orthostatic tachycardia syndrome and adolescent chronic fatigue. J Pediatr 1999; 135: 218225.CrossRefGoogle ScholarPubMed
18. Grubb, BP. Postural tachycardia syndrome. Circulation 2008; 117: 28142817.CrossRefGoogle ScholarPubMed
19. Medow, MS, Stewart, JM. The postural tachycardia syndrome. Cardiol Rev 2007; 15: 6775.CrossRefGoogle ScholarPubMed
20. Massin, MM, Bourguignont, A, Coremans, C, et al. Syncope in pediatric patients presenting to an emergency department. J Pediatr 2004; 145: 223228.CrossRefGoogle ScholarPubMed
21. Zhang, QZ. Diagnosis and management of cardiac syncope in infants. Chin J Pract Pediatr 2004; 19: 644646.Google Scholar
22. Chen, YH, Du, JB. Diagnosis and treatment of cardiogenic syncope in children. J Appl Pediatr 2006; 21: 78.Google Scholar
23. Sheldon, R, Rose, S, Ritchie, D, et al. Historical criteria that distinguish syncope from seizures. J Am Coll Cardiol 2002; 40: 142148.CrossRefGoogle ScholarPubMed
24. Chen, L, Wang, L, Sun, J, et al. Midodrine hydrochloride is effective in the treatment of children with postural orthostatic tachycardia syndrome. Circ J 2011; 75: 927931.CrossRefGoogle ScholarPubMed