Diagnostic Challenges and Outcomes in Transient Loss of Consciousness: A Retrospective Analysis

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Abstract Background Transient loss of consciousness (T-LOC) is a common presenting complaint, posing significant diagnostic challenges. This study explores outcomes for T-LOC. Methods Using the Hospital Inpatient Enquiry System, data on patients with T-LOC were collected at a large academic teaching hospital over six months, including demographics, length of stay (LOS), diagnostic tests, and discharge diagnoses. Results A total of 160 T-LOC patient visits were analysed, divided into three age cohorts: under 65 (n=66), 65-74 (n=38), and over 75 (n=56). Of the 94 patients aged over 65 (58.75% of the sample), mean age was 76.07 years; 47% were female. Diagnostics varied by age, with higher rates of computed tomography of the brain (87.23%) and lying-standing blood pressure (37.23%) in those over 65. Conversely, those over 65 were less likely to receive electrocardiograms (86.17% vs. 96.97%), telemetry (51.06% vs. 59.09%), magnetic resonance imaging of the brain (21.28% vs. 25.76%), transthoracic echocardiograms (14.89% vs. 25.76%), and exercise stress tests (3.19% vs. 10.61%) compared to those under 65. Carotid ultrasound and electroencephalography were infrequently performed across all age groups. Patients aged over 75 were most likely to have a diagnosis (78.57% vs 60.53% in 65-74 and 60.61% in under 65). Orthostatic hypotension was the most common diagnosis 8.51% (8/94) of those over 65. 33.13% (53/160) of patients had no diagnosis documented. LOS increased with age: averaging 6 days (range 1-19) for those under 64, 7.45 days (range 1-36) for those 65-74, and 9.09 days (range 1-64) for those over 75. Older adults were less likely to receive cardiology (19.15%) and neurology consultations (11.70%) compared to those under 65 (27.27% and 36.36%, respectively). Conclusion A considerable number of patients lacked a diagnosis, highlighting the diagnostic complexities of T-LOC. The development of a specialist syncope assessment pathway is underway to improve diagnostics, potentially reducing unnecessary tests and hospital stays.