title: High diagnostic yield and accuracy of history, physical examination, and ECG in patients with transient loss of consciousness in FAST: the Fainting Assessment study.
abstract: BACKGROUND
  Transient loss of consciousness (TLOC) is a common clinical problem.
  
  
  OBJECTIVE
  The aim of this study was to assess the yield and accuracy of the initial evaluation, consisting of standardized history, physical examination, and ECG performed by attending physicians in patients with TLOC.
  
  
  RESULTS
  Five hundred and three adult patients (mean age 53 +/- 19; 56% male) presenting with TLOC to the Academic Medical Center Amsterdam between February 2000 and May 2002 were included in this study. After initial evaluation, the physician made a certain, a highly likely (>80% certain), or no initial diagnosis. Initially undiagnosed patients received additional cardiological testing, additional history taking, and autonomic function tests. After 2 years of follow-up, an expert committee determined the final diagnoses. Two-year follow-up was obtained in 99% of the patients. The yield of certain diagnoses after the initial evaluation was 24%, increasing to 63% after including the highly likely diagnoses. The diagnostic accuracy of the initial certain diagnoses was 93% (95% CI 87-97%), decreasing to 88% (95% CI 84-91%) after inclusion of the initial highly likely diagnoses.
  
  
  CONCLUSIONS
  Attending physicians can make a diagnosis based on initial evaluation in 63% of patients with TLOC, with an overall diagnostic accuracy of 88%. The use of additional testing, beyond history, physical examination, and ECG can be avoided in many patients with TLOC.
authors.affiliation: Departments of Internal Medicine, Academic Medical Center, University of Amsterdam (AMC-UvA), Amsterdam, the Netherlands. n.vandijk@amc.uva.nl
authors.forename: Nynke
authors.initials: N
authors.lastname: van Dijk
authors.forename: Kimberly R
authors.initials: KR
authors.lastname: Boer
authors.forename: Nancy
authors.initials: N
authors.lastname: Colman
authors.forename: Annemieke
authors.initials: A
authors.lastname: Bakker
authors.forename: Jan
authors.initials: J
authors.lastname: Stam
authors.forename: Johannes J M
authors.initials: JJ
authors.lastname: van Grieken
authors.forename: Arthur A M
authors.initials: AA
authors.lastname: Wilde
authors.forename: Mark
authors.initials: M
authors.lastname: Linzer
authors.forename: Johannes B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: Wouter
authors.initials: W
authors.lastname: Wieling
mesh_terms: D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008487:Medical History Taking / Q000706:statistics & numerical data*; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010808:Physical Examination / Q000706:statistics & numerical data*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014474:Unconsciousness / Q000175:diagnosis* / Q000453:epidemiology*