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NHS Evidence, Journal of the American College of Cardiology

Clinical Articles, Lead Article

TLOC – evidence update published by NICE

Studies across Europe suggest that about one visit in 100 to the emergency departments of hospitals are due to fainting/temporary loss of consciousness (TLOC). In 2008 to 2009, nearly 120,000 people in England were admitted to hospital for fainting. Almost half of these were 75 years of age or over, showing that fainting becomes more common with age.1

‘Transient loss of consciousness: Evidence Update March 2012’2 is the latest of a new style Evidence Update from NHS Evidence – a service provided by NICE which focuses on a summary of selected new evidence relevant to NICE clinical guideline 109 ‘Transient loss of consciousness (‘blackouts’) management in adults and young people’ (2010).

Whilst Evidence Updates do not replace current accredited guidance they do highlight new evidence that might generate a future change in practice.

By producing these Evidence Updates NHS Evidence seeks to reduce the need for individuals, managers and commissioners to search for new evidence and to inform guidance developers of new evidence in their field.

In producing the Evidence Update, more than 1,700 pieces of evidence were searched, of which 26 have been chosen for publication. An Evidence Update Advisory Group, comprised of subject experts, has reviewed the prioritised evidence and provided a commentary.

Professor Matthew Cooke, National Clinical Director Urgent and Emergency Care, Department of Health said, ‘It is important to recognise the emerging evidence in this clinical area. This is a very common presentation both as an emergency and as a recurring presentation to primary care. The multiplicity of causes means that it easy to miss important causes but also to over investigate”.

“This evidence update highlights important clinical issues which will make diagnosis more accurate and investigations more specific to the benefit of our patients. I would like to acknowledge the clinical experts who have contributed to this Evidence Update led by Professor Tom Quinn”.

JACC review highlights knowledge gaps

Despite the progress being made, the management of patients with syncope remains largely unsatisfactory because of a significant gap between knowledge and its application, according to a review published recently in the Journal of the American College of Cardiology.3

The authors reviewed the most effective evaluation strategies for patients presenting with syncope using data from several recent articles including the ESC guidelines. They examined two new concepts aimed at filling the gap between knowledge and application, currently under evaluation: syncope facilities with specialist backup and interactive decision-making software.

A standardised assessment can identify those patients suitable for outpatient evaluation and improve the number of patients with a definitive diagnosis while reducing unnecessary testing, they say, possibly including the use of specialised syncope evaluation clinics and/or interactive decision-making software.


1. NHS choices – fainting.

2. Read ‘Transient loss of consciousness: Evidence Update March 2012’ at

3. Brignole M, Hamdan MH. New Concepts in the Assessment of Syncope. JACC 2012;59:1583–91. doi:10.1016/j.jacc.2011.11.056

Published on: May 24, 2012

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