Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage

• Published in: European heart journal 2008-03, Vol.29 (5), p.618-624
• Main Authors: Bartoletti, Angelo, Fabiani, Plinio, Bagnoli, Luciano, Cappelletti, Carlo, Cappellini, Marco, Nappini, Gino, Gianni, Roberto, Lavacchi, Alessandro, Santoro, Giovanni Maria
• Format: Article
• Language: English
• Subjects: Carotid sinus massage; Emergency Service, Hospital - statistics & numerical data; Female; Heart Massage - methods; Humans; Male; Middle Aged; Patient Admission - statistics & numerical data; Physical injury; Syncope; Syncope - complications; Syncope - etiology; Transient loss of consciousness; Wounds and Injuries - etiology
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehm563

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.