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We checked this guideline in March 2019. We found no new evidence that affects the recommendations in this guideline.
Excerpt
There are a number of existing guidelines, for epilepsy, falls and cardiac arrhythmias; which all relate to transient loss of consciousness (TLoC), but there is no guideline which addresses the initial assessment and management of patients who blackout. As such patients may come under the care of a range of clinicians, the lack of a clear pathway contributes to their misdiagnosis, and inappropriate treatment.
This guideline aims to define the appropriate pathways for the initial assessment of these patients, and so to derive the correct underlying diagnosis quickly, efficiently, and cost-effectively, and tailor the management plan to suit their true diagnosis.
Contents
- Key Priorities for Implementation
- Recommendations
- Care Pathways
- 1. Introduction
- 2. Methods
- 2.1. Introduction
- 2.2. Developing key clinical questions (KCQs)
- 2.3. Literature search strategy
- 2.4. How the evidence was reviewed and synthesized
- 2.5. Development of Patient Information Recommendations
- 2.6. Interpretation of the evidence and development of the recommendations
- 2.7. Consensus methodology
- 2.8. Choice of Key Priorities for Implementation (KPI’s)
- 2.9. Consultation
- 2.10. Relationships between the guideline and other national guidance
- 2.11. Research Recommendations
- 2.12. Acknowledgements
- 2.13. Glossary and Abbreviations
- 3. Initial assessment and diagnosis of people who had TLoC
- 4. 12-lead ECG
- 4.1. Clinical Questions
- 4.2. Clinical evidence review: introduction to the use of the standard electrocardiogram
- 4.3. Clinical Evidence Review: 12-lead ECG for predicting serious adverse outcomes in people who had TLoC
- 4.4. Clinical Evidence Review: Automatic 12-lead ECG in diagnosing life threatening arrhythmias in people who may or may not have had TLoC
- 4.5. Clinical evidence review: automatic and manual determination of heart rate, PR interval, QT and QTc intervals in a TLoC population
- 4.6. Health Economics
- 4.7. Evidence Statements
- 4.8. Evidence to recommendations
- 4.9. Recommendations
- 5. Specialist assessment and diagnosis
- 5.1. Clinical Question
- 5.2. Introduction
- 5.3. Clinical Evidence Review: ambulatory ECG following initial assessment for people with (i) a suspected arrhythmic cause of syncope; (ii) with unexplained syncope and (iii) with suspected neurally mediated syncope
- 5.4. Clinical Evidence Review: people with exercise-induced syncope - accuracy of exercise testing
- 5.5. Clinical Evidence Review: people with suspected neurally mediated syncope after initial assessment - accuracy of tilt testing
- 5.6. Clinical Evidence Review: people with suspected neurally mediated syncope after initial assessment - accuracy of carotid sinus massage
- 5.7. Economic review of second stage diagnostic tests
- 5.8. Economic evaluation of ambulatory ECG
- 5.9. Evidence Statements
- 5.10. Evidence to Recommendations
- 5.11. Recommendations
- 6. Diagnostic tests to direct pacing therapy
- 6.1. Clinical Questions
- 6.2. Introduction
- 6.3. Clinical Evidence Review: efficacy of pacemakers in people with suspected neurally mediated syncope with a cardioinhibitory response identified during tilt testing
- 6.4. Clinical Evidence Review: efficacy of pacemakers in people with suspected carotid sinus syncope with a cardioinhibitory response to carotid sinus massage
- 6.5. Clinical Evidence Review: people with suspected neurally mediated syncope after initial assessment - accuracy of tilt testing, ambulatory ECG and carotid sinus massage to direct pacing therapy
- 6.6. Diagnostic test accuracy of tilt testing versus IER as a reference standard for the diagnosis of cardioinhibitory, neurally mediated syncope
- 6.7. Economic evaluation of testing strategies to direct pacing therapy
- 6.8. Evidence Statements
- 6.9. Evidence to Recommendations
- 6.10. Recommendations
- 7 Reference List
- Appendices
- Appendix A. Scope
- Appendix B. Declarations of Interest
- Appendix C1. Clinical Questions
- Appendix C2. Search strategies
- Appendix D1. Included studies characteristics
- Appendix D2. Methodological quality
- Appendix D3. Forest plots, tables, stage one
- Appendix D4. Forest plots, tables, stage two
- Appendix D5. Patient profile for interactive diagnostic simulation
- Appendix D6. Narrative Review
- Appendix E1. Health economic extractions
- Appendix E2. Quality and applicability of HE papers
- Appendix F. All excluded studies
- Appendix G. Further guidance on driving following TLoC
- Appendix H. Quality of Life Review to inform Health Economics
- Appendix I. PSA parameter distributions
Suggested citation:
Westby M, Davis S, Bullock I, Miller P, Cooper P, Turnbull N, Beal R, Braine M, Fear J, Goodwin M, Grünewald R, Jelen P Pawelec J, Petkar S, Pitcher D, Pottle A, Rogers G, Swann G (2010) Transient loss of consciousness (‘blackouts’) management in adults and young people. London: National Clinical Guideline Centre for Acute and Chronic Conditions, Royal College of Physicians.
- Transient loss of consciousness ('blackouts') in over 16s
- Transient loss of consciousness: Evidence Update March 2012: A summary of selected new evidence relevant to NICE clinical guideline 109 'Transient loss of consciousness ('blackouts') management in adults and young people' (2010)
- 2019 surveillance of transient loss of consciousness ('blackouts') in over 16s (NICE guideline CG109)
- Synopsis of the National Institute for Health and Clinical Excellence Guideline for management of transient loss of consciousness.[Ann Intern Med. 2011]Synopsis of the National Institute for Health and Clinical Excellence Guideline for management of transient loss of consciousness.Cooper PN, Westby M, Pitcher DW, Bullock I. Ann Intern Med. 2011 Oct 18; 155(8):543-9. Epub 2011 Sep 19.
- Implantable loop recorders are cost-effective when used to investigate transient loss of consciousness which is either suspected to be arrhythmic or remains unexplained.[Europace. 2012]Implantable loop recorders are cost-effective when used to investigate transient loss of consciousness which is either suspected to be arrhythmic or remains unexplained.Davis S, Westby M, Pitcher D, Petkar S. Europace. 2012 Mar; 14(3):402-9. Epub 2011 Nov 8.
- Clinical Practice Guideline: Evaluation of the Neck Mass in Adults.[Otolaryngol Head Neck Surg. 2017]Clinical Practice Guideline: Evaluation of the Neck Mass in Adults.Pynnonen MA, Gillespie MB, Roman B, Rosenfeld RM, Tunkel DE, Bontempo L, Brook I, Chick DA, Colandrea M, Finestone SA, et al. Otolaryngol Head Neck Surg. 2017 Sep; 157(2_suppl):S1-S30.
- Review Transient loss of consciousness and syncope.[Handb Clin Neurol. 2014]Review Transient loss of consciousness and syncope.Bassetti CL. Handb Clin Neurol. 2014; 119:169-91.
- Review Diagnostic criteria to aid the differential diagnosis of patients presenting with transient loss of consciousness: A systematic review.[Seizure. 2018]Review Diagnostic criteria to aid the differential diagnosis of patients presenting with transient loss of consciousness: A systematic review.Wardrope A, Newberry E, Reuber M. Seizure. 2018 Oct; 61:139-148. Epub 2018 Aug 16.
- Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young Peo...Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young People
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