People who suffer from blackouts may be going undiagnosed, says NICE
People who experience spontaneous blackouts may be missing out on an accurate and timely diagnosis of their symptoms because of inadequate assessments made by healthcare staff, NICE has warned.
Delays in diagnosing blackouts could result in any underlying causes of a blackout, such as heart disease or epilepsy, going undetected.
Around half of the UK population will experience blackouts, also known as transient loss of consciousness, at some point in their lives. For most people, there will be a simple explanation, like being stressed or anxious, but for some it can be caused by cardiovascular or neurological problems.
This latest guidance calls for GPs, paramedics and other health professionals to assume that the symptoms of a blackout are serious until proven otherwise.
They should establish the specific circumstances that occurred before, during and after the suspected blackout, either directly from the person, or from any witnesses.
If the initial assessment does not reveal any concerns, and if the blackout is symptomatic of an uncomplicated faint, then no further immediate management is needed.
However, if there are uncertainties, the healthcare professional should offer a number of tests, including a 12-lead electrocardiogram (ECG).
If this reveals possible abnormalities, or if the person has a family history of heart disease, has blacked out during exertion, or has unexplained breathlessness, then this may indicate that the underlying cause could be cardiovascular and the person should be referred to a cardiovascular specialist within 24 hours for further tests.
Alternatively, if a witness reveals that the person suffered limb-jerking or bit his or her tongue during the blackout, or experienced confusion or disorientation once they regained consciousness, then this could mean that the cause is neurological. NICE advises that the person should then be seen by an epilepsy specialist within 2 weeks.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said: “Although transient loss of consciousness is a very common symptom that the NHS deals with on a daily basis, its diagnosis can often be inaccurate, inefficient and delayed.
“For example, some people with epilepsy may also have a heart problem which has caused them to blackout, which could initially be overlooked as the healthcare professional may believe that he or she already has the correct diagnosis.
“Lapses such as these could lead to delays in treatment for the cardiovascular cause, which subsequently could put the patient's health at further risk.
“Our clinical guideline hopes to address the huge variation in clinical practice across the NHS, regarding what healthcare professionals should do when they are first presented with people who may have experienced blackouts, as well as when they should consider referring them to specialists for further investigation. It has been based on the most up to date research and so represents best practice for the NHS.”
Dr Paul Cooper, a Consultant Neurologist at Salford Royal Hospital in Manchester and Chair of the Guideline Development Group added: “While most people will have a situational or uncomplicated cause for their blackout, which doesn't require a referral to a specialist, the NICE guideline calls for all healthcare professionals carrying out the initial assessment to assume the symptom is serious until proven otherwise. There are lots of possible causes for transient loss of consciousness and so having a standardised, clinical pathway is crucial.”
25 August 2010
This page was last updated: 24 August 2010