Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage.
OBJECTIVE
To evaluate the prevalence and the characteristics of secondary trauma among patients referred to the emergency department (ED) for a transient loss of consciousness (TLOC).


RESULTS
Over a 24 months period, all the patients referred to our ED for a TLOC were evaluated according to the ESC Guidelines on Syncope and enrolled in the study. Among 1253 consecutive patients with TLOC (1114 with a true syncope and 139 with a non-syncopal condition) 365 (29.1%) reported a trauma, in 59 cases (4.7%) severe. The frequency and the characteristics of trauma did not differ among the two main categories of TLOC. Out of 54 patients with syncope and a severe trauma, 20 (37%) had a definite diagnosis after a guidelines-based initial evaluation, and further 17 (31.5%) during the hospital course. Among these latter, carotid sinus syndrome was by far the most common diagnosis.


CONCLUSIONS
Among patients referred to the ED for a TLOC secondary trauma is a common complication, whose characteristics are of little utility to discover the specific cause of the symptom. For older patients with syncope complicated by a severe trauma carotid sinus massage should be the first diagnostic manoeuvre to be undertaken after a non-diagnostic initial evaluation.
Bartoletti
Angelo
A
Cardiology Division, Nuovo San Giovanni di Dio Hospital, Florence, Italy. angelobartoletti@alice.it
Fabiani
Plinio
P
Bagnoli
Luciano
L
Cappelletti
Carlo
C
Cappellini
Marco
M
Nappini
Gino
G
Gianni
Roberto
R
Lavacchi
Alessandro
A
Santoro
Giovanni Maria
GM
D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D013575:Syncope / Q000150:complications* / Q000209:etiology; D014947:Wounds and Injuries / Q000209:etiology*