Transient loss of consciousness—initial assessment, diagnosis, and specialist referral: summary of NICE guidance

Transient loss of consciousness is a spontaneous loss of consciousness with complete recovery, affecting a quarter to half of the population at some point in their lives.1 2 3 The condition has many possible causes, including cardiovascular disorders (ranging from cardiac arrhythmias to vasovagal syncope), epilepsy, and psychogenic attacks. Diagnosis is often inaccurate, inefficient, and delayed, and management varies considerably.1 Experience shows that the importance of obtaining information on the event itself and the need for early electrocardiography are not widely appreciated. This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of transient loss of consciousness in people aged 16 and over.4 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. The recommendations emphasise elements of the diagnostic algorithm published in the Quick Reference Guide version of the NICE guidance, to which the reader should refer.4 Evidence levels for the recommendations are given in italic in square brackets ### Initial assessment