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NICE Quality Standard on transient loss of consciousness

NICE has now published a Quality Standard on transient loss of consciousness

Transient loss of consciousness is very common, affecting up to half the population in the UK at some point in their lives. It is defined as spontaneous loss of consciousness with complete recovery. In this context, complete recovery would involve full recovery of consciousness without any residual neurological deficit. An episode is often described as a 'blackout' or a 'collapse', but some people collapse without transient loss of consciousness; this quality standard does not cover that situation. There are various causes of transient loss of consciousness, including cardiovascular disorders (which are the most common), neurological conditions such as epilepsy, and psychogenic attacks.

Approximately 3–5% of adults who attend accident and emergency departments do so because of transient loss of consciousness; this accounts for up to 6% of urgent hospital admissions. It is particularly common in people aged 65 and older; it has been estimated that up to 23% of this group experience syncope (transient loss of consciousness due to a reduction in blood supply to the brain) over a 10‑year period, and there is a high rate of recurrence. Reflex (vasovagal) syncope (which is usually benign) is common in younger people. Many younger people who have a vasovagal syncope episode may not seek medical help, so the true incidence of transient losses of consciousness – especially in younger people – is uncertain.

The diagnosis of the underlying cause of transient loss of consciousness is often inaccurate, inefficient and delayed. In addition, there is huge variation in the management of transient loss of consciousness. A substantial proportion of people initially diagnosed with and treated for epilepsy in fact have a cardiovascular cause for transient loss of consciousness. Some people have expensive or inappropriate tests, unnecessary referral or referral to the wrong specialty; whereas others with potentially dangerous conditions may not receive the correct assessment, diagnosis and treatment.

The aim of initial assessment, diagnosis and specialist referral of people who have had a transient loss of consciousness is to ensure that that they receive the correct diagnosis quickly, efficiently and cost effectively, leading to a suitable management plan for the underlying cause.

The quality standard is expected to contribute to improvements in the following outcomes:

  • Emergency hospital admissions.
  • Specialist referrals.
  • Mortality from causes considered preventable.
  • Patient experience of clinical care.
  • Misdiagnosis of the cause of transient loss of consciousness.

To read more, click here (re-direct to NICE website with full standard)

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