title: Transient loss of consciousness with and without injuries: where to treat these patients?
abstract: OBJECTIVE
  Transient loss of consciousness (LOC) is a fairly common phenomenon and frequently carries a risk of injury. The aim was to study the occurrence of injuries and causes of emergency referrals versus later specialist consultation in association with LOC in the primary healthcare setting.
  
  
  METHODS
  A four-month survey was carried out in the Primary Healthcare Emergency Department of the City of Tampere, Finland (198,000 inhabitants). The subjects comprised consecutive patients aged at least 15 years, attending a primary healthcare emergency department because of LOC. The type of LOC was determined (seizure, syncope and uncertain) and the type and site of all injuries associated with LOC were registered. All referrals to hospital or specialist consultation because of LOC were also registered and the predictors of admission were analysed by logistic regression modelling.
  
  
  RESULTS
  Injury was associated with 43 (20%) out of 220 visits because of LOC; in 12/72 (17%) cases with syncope, in 24/118 (20%) with seizures and in 7/30 (23%) with an uncertain cause of LOC. Most of the injuries were minor. Emergency referral was required in 45/220 (20%) cases of LOC. Coronary heart disease and injury were the main predictors of emergency referral to hospital.
  
  
  CONCLUSIONS
  Injuries are as frequent in patients with syncope as in those suffering seizures. Most patients with LOC in primary healthcare emergency departments do not seem to require emergency admission to hospital.
authors.affiliation: Health Centre of the City of Tampere, Tampere City Hospital, Finland. kirsti.martikainen@parkinson.fi
authors.forename: Kirsti
authors.initials: K
authors.lastname: Martikainen
authors.forename: Kaija
authors.initials: K
authors.lastname: Seppä
authors.forename: Paula
authors.initials: P
authors.lastname: Viita
authors.forename: Sulo
authors.initials: S
authors.lastname: Rajala
authors.forename: Pekka
authors.initials: P
authors.lastname: Laippala
authors.forename: Tapani
authors.initials: T
authors.lastname: Keränen
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D014218:Triage; D014474:Unconsciousness / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000453:epidemiology*