The Management of Transient Loss of Consciousness (TLOC) and Suspected Syncope in European Emergency Departments: a Prospective Cohort Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Syncope
- Sponsor
- NHS Lothian
- Enrollment
- 952
- Locations
- 57
- Primary Endpoint
- Referral source
- Status
- Completed
- Last Updated
- 3 years ago
Overview
Brief Summary
Prospective multi centre cohort study examining the clinical presentation, diagnostic tests, and management of adult Emergency Department (ED) patients presenting with Transient Loss of Consciousness (TLOC) either undifferentiated or thought to be of syncopal origin.
Detailed Description
Syncope is a common ED problem. The three underlying causes are reflex (simple faint), orthostatic hypotension (blood pressure fall on standing) and cardiac disease (structural heart disease or cardiac dysrhythmia). Diagnosis is difficult and is not apparent in \~50% of patients after assessment. For the first time, European Society of Cardiology (ESC) guidelines incorporating ED management of patients presenting with TLOC, either undifferentiated or thought to be of syncopal origin, have been produced. However, very little is currently known about the use of diagnostic algorithms and management of this patient group in EDs across Europe. As a result, the application of guidelines and the management of TLOC by European Society of Emergency Medicine (EUSEM) members in different countries and hospitals, cannot yet be recommended for use in settings other than those where they have been successfully validated. This study aims to describe the prevalence, clinical presentation, current assessment, management strategies and ESC risk categories of patients presenting with TLOC (undifferentiated or thought to be of syncopal origin) to the ED, and will provide data to help identify the gaps in our knowledge and practice, and areas where further research and development work is required to fully implement European Society of Cardiology (ESC) guidelines within European EDs.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Adult patients (≥18 years old) assessed in the ED with TLOC thought to be of syncopal origin.
Exclusion Criteria
- •Inability to consent
- •Patient in custody or prison
- •Aged \<18 years
- •TLOC thought to be due to neurological seizure (e.g., epilepsy/alcohol or drug withdrawal) or trauma
Outcomes
Primary Outcomes
Referral source
Time Frame: Admission
Referral source
Participant gender
Time Frame: Admission
Participant gender
Participant age
Time Frame: Admission
Participant age
Mode of arrival
Time Frame: Admission
Mode of arrival
ESC high-risk 'past medical history' features
Time Frame: Admission
Which European Society of Cardiology syncope high-risk 'past medical history' features are present
Presence of any European Society of Cardiology (ESC) syncope high-risk history features
Time Frame: Admission
Which European Society of Cardiology syncope high-risk history features are present
Other medical comorbidities
Time Frame: Admission
Other medical comorbidities
Blood pressure (BP) on admission
Time Frame: Admission
First Blood pressure (BP) measure in the Emergency Department in mmHg
ESC high risk 'physical examination' factors
Time Frame: Admission
ESC high risk 'physical examination' factors
Troponin levels
Time Frame: Admission
Troponin levels
D-dimer levels
Time Frame: Admission
D-dimer levels
Copeptin levels
Time Frame: Admission
Copeptin levels
Rockwood Clinical Frailty Scale score
Time Frame: Admission
Rockwood Clinical Frailty Scale is a well validated score ranging from 1 (Very Fit) to 9 (Terminally Ill) with defined descriptions for each category.
Pulse rate on admission
Time Frame: Admission
First pulse rate measured in the Emergency Department in beats per minute
Lying/standing systolic BP difference on admission
Time Frame: Admission
First lying/standing systolic BP difference measured in the Emergency Department in mmHg
Number of participants with abnormal Electrocardiogram (ECG) readings
Time Frame: Admission
Number of participants with abnormal ECG readings
Reason(s) for admission
Time Frame: Admission
Reason(s) for admission
Whether driving and occupation advice given
Time Frame: Admission
Whether driving and occupation advice given
Status at discharge from hospital
Time Frame: 30 days
Status at discharge from hospital
Natriuretic peptides levels
Time Frame: Admission
Natriuretic peptides levels
ED clinician diagnosis
Time Frame: Admission
ED clinician diagnosis - descriptive
Patient destination
Time Frame: Admission
Descriptive options: Admitted to Observation/Clinical Decision Unit/Same Day Emergency Care unit/hospital floor with telemetry monitoring/hospital floor with no telemetry monitoring. Discharged to outpatient follow up/family doctor/General Practitioner care/home with no follow up
Length of hospital stay in days
Time Frame: 30 days
Length of hospital stay in days
Hospital discharge diagnosis
Time Frame: 30 days
Hospital discharge diagnosis