A structured clinical work-up using ESC guidelines for transient loss of consciousness achieved a diagnostic yield of 97.0% and an overall diagnostic accuracy of 90.6% (95% CI: 86.2-93.8%).
Cohort (n=264)
No
Does a structured diagnostic approach based on ESC guidelines provide high diagnostic yield and accuracy in patients with transient loss of consciousness?
A structured clinical work-up for syncope based on ESC guidelines yields a high diagnostic accuracy of 90.6%, with history taking being the most critical component.
Abstract Aims To assess in patients with transient loss of consciousness the diagnostic yield, accuracy, and safety of the structured approach as described in the ESC guidelines in a tertiary referral syncope unit. Methods and results Prospective cohort study including 264 consecutive patients (≥18 years) referred with at least one self-reported episode of transient loss of consciousness and presenting to the syncope unit between October 2012 and February 2015. The study consisted of three phases: history taking (Phase 1), autonomic function tests (AFTs) (Phase 2), and after 1.5-year follow-up with assessment by a multidisciplinary committee (Phase 3). Diagnostic yield was assessed after Phases 1 and 2. Empirical diagnostic accuracy was measured for diagnoses according to the ESC guidelines after Phase 3. The diagnostic yield after Phase 1 (history taking) was 94.7% (95% CI: 91.1–97.0%, 250/264 patients) and increased to 97.0% (93.9–98.6%, 256/264 patients) after Phase 2. The overall diagnostic accuracy (as established in Phase 3) of the Phases 1 and 2 diagnoses was 90.6% (95% CI: 86.2–93.8%, 232/256 patients). No life-threatening conditions were missed. Three patients died, two unrelated to the cause of transient loss of consciousness, and one whom remained undiagnosed. Conclusion A clinical work-up at a tertiary syncope unit using the ESC guidelines has a high diagnostic yield, accuracy, and safety. History taking (Phase 1) is the most important diagnostic tool. Autonomic function tests never changed the Phase 1 diagnosis but helped to increase the certainty of the Phase 1 diagnosis in many patients and yield additional diagnoses in patients who remained undiagnosed after Phase 1. Diagnoses were inaccurate in 9.4%, but no serious conditions were missed. This is adequate for clinical practice.
Jong et al. (Tue,) conducted a cohort in Transient loss of consciousness (n=264). ESC guidelines structured approach was evaluated on Overall diagnostic accuracy of Phase 1 and 2 diagnoses (95% CI 86.2-93.8). A structured clinical work-up using ESC guidelines for transient loss of consciousness achieved a diagnostic yield of 97.0% and an overall diagnostic accuracy of 90.6% (95% CI: 86.2-93.8%).