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

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%. To provide an emergency-department risk-stratified diagnostic and disposition framework for pediatric syncope. 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. A standardized ED syncope pathway based on risk tiers and ECG-first evaluation improves patient safety while reducing unnecessary admissions and testing. Not applicable.