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Arch Hellen Med, 27(2), March-April 2010, 202-207


Epidemiology and clinical assessment of patients
presenting at the emergency department with loss of consciousness

Department of Clinical Therapeutics, University of Athens, "Alexandra" General Hospital, Athens, Greece

OBJECTIVE The objective of this study was to evaluate the epidemiological data of patients presenting with transient loss of consciousness (TLOC) at the emergency department (ED) during the course of one year.

METHOD All cases of patients with TLOC presenting at the ED between October 2006 and October 2007 were analysed in a retrospective, observational study. The demographic characteristics, and the initial clinical evaluation, including careful medical history, physical examination and a 12-lead electrocardiogram (ECG) were recorded.

RESULTS Of 13,909 patients examined at the ED during one year, 151 cases of TLOC were recorded (1.1%), 66 male (43.7%) and 85 female (56.3%) subjects. Overall, 124 of 151 patients (82.1%) presenting with TLOC were admitted for hospitalization, accounting for 1.5% of all hospital admissions for that period. Hospitalized patients were significantly older than the subjects discharged from the ED (69.9±14 years vs 34.7±17 years, p<0.001). In 50 of 151 cases with TLOC (33%) there was evidence of underlying heart disease, and diagnosis based on initial assessment was made in 29 of these (58%), and arrhythmogenic syncope was identified in 19 (38%). Further assessment during hospitalization permitted the diagnosis in a further 9 patients with heart disease (18%), while the cause of syncope could not be determined in 12 (24%). Patients with syncope and structural heart disease were hospitalized in a significantly greater proportion than subjects without heart disease (x2=16.27, p<0.001). A total of 26 of the 151 patients with TLOC were discharged from the ED (19.9%), in whom diagnosis was established from the initial evaluation in 16 (61.5%). Causes of TLOC in discharged patients included vasovagal syncope in 7 (26.9%), orthostatic hypotension in 4 (15.3%) and conversion disorder in 5 (19.2%).

CONCLUSIONS Older age and the presence of heart disease combined with historical and electrocardiographic criteria can be used to guide hospital admission of patients presenting with TLOC at the ED.

Key words: Arrhythmias, Electrocardiogram, Emergency department, Syncope.

© Archives of Hellenic Medicine