Age‑Based Differences in Syncope: Incidence, Diagnostic Challenges, and Treatment Strategies in Pediatric vs. Adult Populations Attending a Tertiary Cardiac Center in Pakistan

Background:Syncope presents a frequent diagnostic dilemma, particularly in low-resource settings like Pakistan, where age-related variations in presentation and management are poorly characterised. This study sought to compare the clinical profiles, triggers, and recurrence predictors of syncope across paediatric and adult populations attending a tertiary cardiac centre. Methods:A cross-sectional study was conducted at the Department of Cardiology, Quaid-e-Azam Medical College, Bahawalpur, from January 2024 to May 2025. Using non-probability consecutive sampling, 220 patients with recent-onset syncope were enrolled, including 90 paediatric and 130 adult participants. Standardised clinical evaluations and investigations, including ECG, echocardiography, and laboratory parameters, were performed. Data were analysed using Shapiro–Wilk for normality, followed by t-test, Mann–Whitney U, chi-square, and logistic regression for group comparisons and predictors of recurrence. Results:The mean age of participants was 33.1 ± 18.7 years, with males comprising 55.9%. Vasovagal syncope was most prevalent (50.5%), and cardiac syncope was more frequent in adults (χ² = 22.03, p < 0.001). Adults showed higher serum glucose (163.5 mg/dL, IQR: 128.1–201.4, p < 0.001) and electrolyte levels (138.7 mEq/L, IQR: 137.2–140.9, p = 0.017). Syncope recurrence occurred in 19.1% and was significantly associated with cardiac syncope (OR 3.21, p = 0.001), abnormal echocardiography (OR 2.94, p = 0.007), and psychiatric comorbidity (OR 1.87, p = 0.042). Positive correlations were observed between glucose and episode frequency (ρ = 0.364, p < 0.001). Conclusion:Significant clinical, biochemical, and diagnostic differences were identified between paediatric and adult syncope patients. Cardiac involvement and psychosocial factors emerged as key predictors of recurrence, underscoring the need for age-tailored syncope assessment pathways in Pakistani tertiary care settings.