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Diagnostic testing for SVT usually can be skipped

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Contemporary PEDS Journal, May 2022, Volume 39, Issue 4

A visit to the emergency department for supraventricular tachycardia (SVT) will often result in a battery of tests. The often normal results for those tests raise the question of whether they're needed.

Children visiting the emergency department (ED) for management of supraventricular tachycardia (SVT) often undergo diagnostic tests, and the results almost always are normal; even when abnormal, the results are overwhelmingly clinically irrelevant. These were the chief findings of a retrospective study in patients presenting for management of SVT at a single urban tertiary care center during a 7-year period.

The mean age of the 40 patients (who had a total of 92 encounters) was 8.6 years; 50% had a history of SVT and 35% had comorbidities, most often asthma. During the study period, slightly more than half (52.5%) had 1 ED visit, 32.5% had 2 or 3, and 6 had 4 to 17.

More than two-thirds (67%) of patients underwent serologic laboratory evaluation. Eight children had an abnormality, just 1 of which was considered clinically significant enough to warrant intervention. Almost 30% of patients had chest radiography, which revealed no significant findings. Investigators concluded that routine laboratory or radiographic investigation in this population may be unwarranted, given the risk of false-positive results, patient and parent discomfort, and study cost.

Thoughts from Dr. Farber

Readers of this section should know I am a big proponent of “less is more” when it comes to testing, and here is another reason. When you see a child with SVT, it usually will be sufficient to restore normal rhythm and then refer to cardiology for evaluation.

Reference

Taylor RA, Thomas R, Lawrence D. Nonutility of diagnostic testing in ambulatory patients with supraventricular tachycardia. Pediatr Emerg Care. 2022;38(3):e1036-e1040. doi:10.1097/ PEC.0000000000002649