• Gonzalo Baron-Esquivias, Jesús Martínez-Alday, Alfonso Martín, Angel Moya, Roberto García-Civera, M Paz López-Chicharro, María Martín-Mendez, Carmen del Arco, and Pedro Laguna.
• Department of Cardiology, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot s/n., 41013 Sevilla, Spain. gbaron@jet.es
• Europace. 2010 Jun 1; 12 (6): 869-76.

AimsTo assess the clinical presentation and acute management of patients with transient loss of consciousness (T-LOC) in the emergency department (ED).Methods And ResultsA multi-centre prospective observational study was carried out in 19 Spanish hospitals over 1 month. The patients included were > or =14 years old and were admitted to the ED because of an episode of T-LOC. Questionnaires and corresponding electrocardiograms (ECGs) were reviewed by a Steering Committee (SC) to unify diagnostic criteria, evaluate adherence to guidelines, and diagnose correctly the ECGs. We included 1419 patients (prevalence, 1.14%). ECG was performed in 1335 patients (94%) in the ED: 498 (37.3%) ECGs were classified as abnormal. The positive diagnostic yield ranged from 0% for the chest X-ray to 12% for the orthostatic test. In the ED, 1217 (86%) patients received a final diagnosis of syncope, whereas the remaining 202 (14%) were diagnosed of non-syncopal transient loss of consciousness (NST-LOC). After final review by the SC, 1080 patients (76%) were diagnosed of syncope, whereas 339 (24%) were diagnosed of NST-LOC (P < 0.001). Syncope was diagnosed correctly in 84% of patients. Only 25% of patients with T-LOC were admitted to hospitals.ConclusionAdherence to clinical guidelines for syncope management was low; many diagnostic tests were performed with low diagnostic yield. Important differences were observed between syncope diagnoses at the ED and by SC decision.

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