title: Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage.
abstract: 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.
authors: Cardiology Division, Nuovo San Giovanni di Dio Hospital, Florence, Italy. angelobartoletti@alice.it
authors: Angelo
authors: A
authors: Bartoletti
authors: Plinio
authors: P
authors: Fabiani
authors: Luciano
authors: L
authors: Bagnoli
authors: Carlo
authors: C
authors: Cappelletti
authors: Marco
authors: M
authors: Cappellini
authors: Gino
authors: G
authors: Nappini
authors: Roberto
authors: R
authors: Gianni
authors: Alessandro
authors: A
authors: Lavacchi
authors: Giovanni Maria
authors: GM
authors: Santoro
mesh_terms: 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*