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Background <p>Pediatric syncope accounts for 1–3% of emergency department (ED) visits. Although most cases are benign, 4% are caused by cardiac disease and 3% by seizures, which carry a risk of sudden death or neurologic injury if missed. Vasovagal syncope accounts for 52–74% of cases and postural orthostatic tachycardia syndrome (POTS) for approximately 13%.</p> Objective <p>To provide an emergency-department risk-stratified diagnostic and disposition framework for pediatric syncope.</p> Key findings <p>A universal 12-lead electrocardiogram (ECG) identifies nearly all life-threatening cardiac causes of syncope. When combined with structured red-flag screening and clinical risk stratification, patients can be reliably divided into low-, intermediate-, and high-risk groups, allowing safe discharge of benign cases and rapid admission of dangerous ones.</p> Conclusion <p>A standardized ED syncope pathway based on risk tiers and ECG-first evaluation improves patient safety while reducing unnecessary admissions and testing.</p> Clinical trial number <p>Not applicable.</p>

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Pediatric syncope in the emergency department: a risk-stratified diagnostic and disposition pathway

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月14日

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  • Khaled Abouelmagd,
  • Mariam Mohamed Mousa,
  • Sohaila Mohamed Mohamed Abdelbar,
  • Gabriela Berger,
  • Sara Nalli,
  • Alaa Mahmoud Zawrah,
  • Kisa Fatima,
  • Mohammed Alsabri

摘要

Background

Pediatric syncope accounts for 1–3% of emergency department (ED) visits. Although most cases are benign, 4% are caused by cardiac disease and 3% by seizures, which carry a risk of sudden death or neurologic injury if missed. Vasovagal syncope accounts for 52–74% of cases and postural orthostatic tachycardia syndrome (POTS) for approximately 13%.

Objective

To provide an emergency-department risk-stratified diagnostic and disposition framework for pediatric syncope.

Key findings

A universal 12-lead electrocardiogram (ECG) identifies nearly all life-threatening cardiac causes of syncope. When combined with structured red-flag screening and clinical risk stratification, patients can be reliably divided into low-, intermediate-, and high-risk groups, allowing safe discharge of benign cases and rapid admission of dangerous ones.

Conclusion

A standardized ED syncope pathway based on risk tiers and ECG-first evaluation improves patient safety while reducing unnecessary admissions and testing.

Clinical trial number

Not applicable.