NICE guideline: transient loss of consciousness (blackouts) in adults and young people

Abstract

Transient loss of consciousness (TLoC) is loss of consciousness with complete recovery. It is commonly described by the patient as a blackout. TLoC is very common and people who experience it may present to GPs during surgery hours or out of hours, or they may be referred from the ambulance services or the emergency department. There are a number of potential causes of TLoC: The diagnosis of the underlying cause is often inaccurate, inefficient, and delayed, and misdiagnosis is common. NICE guideline CG1091 aims to define the appropriate pathways for the assessment of patients who experience TLoC, in order to obtain the correct underlying diagnosis quickly, efficiently, and cost-effectively, and to tailor a management plan to suit their true diagnosis. The guideline includes advice on the management of uncomplicated faint/situational syncope and orthostatic hypotension, as well as on detailed testing and assessment of those people considered to have a cardiovascular cause for their TLoC. ### Initial assessment The guidance most relevant to GPs is likely to concern those areas related to initial assessment in order to determine whether the person has had TLoC, the possible causes of it, and the appropriate next steps. #### History Ask the person who has had the suspected TLoC, as well as any witnesses, to describe what happened before, during, and after the event. Try to contact, by telephone, any witnesses who are not present at the consultation. Record details about: