European Heart Journal Advance Access published online on December 16, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm563
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Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage
1 Cardiology Division, Nuovo San Giovanni di Dio Hospital, Florence, Italy
2 Internal Medicine Department, Nuovo San Giovanni di Dio Hospital, Florence, Italy
3 Emergency Department, Nuovo San Giovanni di Dio Hospital, Florence, Italy
Received 24 February 2007; revised 24 October 2007; accepted 12 November 2007.
* Corresponding author: Costa dei Magnoli 28, 50125 Florence, Italy. Tel.: +39 055 2346149, Fax: +39 055 7192399, Email: angelobartoletti{at}alice.it
Aims: To evaluate the prevalence and the characteristics of secondary trauma among patients referred to the emergency department (ED) for a transient loss of consciousness (TLOC).
Methods and results: Over a 24 months period, all the patients referred to our ED for a TLOC were evaluated according to the ESC Guidelines on Syncope and enrolled in the study. Among 1253 consecutive patients with TLOC (1114 with a true syncope and 139 with a non-syncopal condition) 365 (29.1%) reported a trauma, in 59 cases (4.7%) severe. The frequency and the characteristics of trauma did not differ among the two main categories of TLOC. Out of 54 patients with syncope and a severe trauma, 20 (37%) had a definite diagnosis after a guidelines-based initial evaluation, and further 17 (31.5%) during the hospital course. Among these latter, carotid sinus syndrome was by far the most common diagnosis.
Conclusion: Among patients referred to the ED for a TLOC secondary trauma is a common complication, whose characteristics are of little utility to discover the specific cause of the symptom. For older patients with syncope complicated by a severe trauma carotid sinus massage should be the first diagnostic manoeuvre to be undertaken after a non-diagnostic initial evaluation.
Key Words: Transient loss of consciousness • Syncope • Physical injury • Carotid sinus massage
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