Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage

Eur Heart J. 2008 Mar;29(5):618-24. doi: 10.1093/eurheartj/ehm563. Epub 2007 Dec 16.


Aims: 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).

Methods and 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.

Conclusion: 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.

Publication types

  • Evaluation Study

MeSH terms

  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Heart Massage / methods*
  • Humans
  • Male
  • Middle Aged
  • Patient Admission / statistics & numerical data
  • Syncope / complications*
  • Syncope / etiology
  • Wounds and Injuries / etiology*