Practice Guidelines

Transient loss of consciousness—initial assessment, diagnosis, and specialist referral: summary of NICE guidance

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c4457 (Published 02 September 2010) Cite this as: BMJ 2010;341:c4457
  1. Maggie Westby, clinical effectiveness lead1,
  2. Ian Bullock, chief operating officer and guideline lead1,
  3. Paul N Cooper, consultant neurologist2,
  4. Sarah Davis, senior lecturer in health economics3
  5. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians of London, London NW1 4LE
  2. 2Greater Manchester Neurosciences Centre, Salford Royal Foundation Trust (Hope Hospital), Salford
  3. 3Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA
  1. Correspondence to: P N Cooper paul.cooper{at}manchester.ac.uk

    Transient loss of consciousness is a spontaneous loss of consciousness with complete recovery, affecting a quarter to half of the population at some point in their lives.1 2 3 The condition has many possible causes, including cardiovascular disorders (ranging from cardiac arrhythmias to vasovagal syncope), epilepsy, and psychogenic attacks. Diagnosis is often inaccurate, inefficient, and delayed, and management varies considerably.1 Experience shows that the importance of obtaining information on the event itself and the need for early electrocardiography are not widely appreciated. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of transient loss of consciousness in people aged 16 and over.4

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. The recommendations emphasise elements of the diagnostic algorithm published in the Quick Reference Guide version of the NICE guidance, to which the reader should refer.4 Evidence levels for the recommendations are given in italic in square brackets

    Initial assessment

    • At any stage, including initial presentation, if the person has sustained an injury or has not made a full recovery of consciousness, or if transient loss of consciousness is secondary to a condition that needs immediate action, use clinical judgment to determine appropriate management and the urgency of treatment. [Based on the experience and opinion of the Guideline Development Group (GDG)]

    • Ask the person with suspected transient loss of consciousness, and any witnesses (try to contact these by phone if necessary), to describe what happened:

      • -Before the event (circumstances, posture, prodromal symptoms)

      • -During the event (appearance and colour; movement; any tongue biting or injury; and duration …

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