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

Authors

• Khaled Abouelmagd
• Mariam Mohamed Mousa
• Sohaila Mohamed Mohamed Abdelbar
• Gabriela Berger
• Sara Nalli
• Alaa Mahmoud Zawrah
• Kisa Fatima
• Mohammed Alsabri, Pediatric Emergency Department, Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA, USAFollow

Document Type

Article

Publication Date

4-14-2026

Abstract

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.

Publication Title

Int J Emerg Med

Volume

19

Issue

1

Recommended Citation

Abouelmagd, K., Mohamed Mousa, M., Mohamed Mohamed Abdelbar, S., Berger, G., Nalli, S., Zawrah, A., Fatima, K., & Alsabri, M. (2026). Pediatric syncope in the emergency department: a risk-stratified diagnostic and disposition pathway.. Int J Emerg Med, 19 (1) https://doi.org/https://doi.org/10.1186/s12245-026-01215-z