Diagnostic criteria to aid the differential diagnosis of patients presenting with transient loss of consciousness: A systematic review

Seizure : the Journal of the British Epilepsy Association
Alistair WardropeMarkus Reuber

Abstract

Transient loss of consciousness (TLOC) is a common presentation in primary care. Over 90% of these are due to epileptic seizures (ES), syncope, or psychogenic non-epileptic seizures (PNES). Misdiagnosis rates are as high as 30%. Systematic review of inter-ictal clinical criteria to aid differential diagnosis of TLOC. We searched Medline, EMBASE, CINAHL and PsycInfo databases, as well as relevant grey literature depositories and citations of relevant reviews and guidelines for studies giving sensitivity and specificity of inter-ictal clinical characteristics used to differentiate between causes of TLOC. Two independent reviewers selected studies for inclusion and performed critical appraisal of included articles. We performed a narrative synthesis of included studies. Of 1023 results, 16 papers were included. Two compared syncope, ES, and PNES; all others compared ES and PNES. All were at significant risk of bias in at least one domain. 6 studied patient symptoms, 6 medical and social history, 3 witness reports and 1 examination findings. No individual criterion differentiated between diagnoses with high sensitivity and specificity. There is a lack of validated diagnostic criteria to help clinicians assessing patients in primary...Continue Reading

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Citations

Mar 4, 2020·Journal of Clinical Medicine·Francisco Martín-RodríguezJosé Luis Martín-Conty
May 15, 2020·British Journal of Nursing : BJN·Rachael Bailey, Gerri Mortimore
Jan 30, 2021·Autonomic Neuroscience : Basic & Clinical·Fahad BashiriAbdullah Alhuzaimi
Feb 24, 2021·Seizure : the Journal of the British Epilepsy Association·Wesley T KerrJohn M Stern
Feb 19, 2021·Seizure : the Journal of the British Epilepsy Association·Wesley T KerrJohn M Stern
Apr 21, 2020·Neurology. Clinical Practice·Alistair WardropeMarkus Reuber

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