Central Manchester Foundation Hospital Trust.
Clin Med (Lond). 2011 Feb;11(1):11-6. doi: 10.7861/clinmedicine.11-1-11.
Transient loss of consciousness (T-LOC), or blackout, is common in acute medicine. Clinical skills are not done well, with at least 74,000 patients misdiagnosed and mistreated for epilepsy in England alone. The aim of this study was to provide a rapid, structured assessment and an electrocardiogram (ECG) for patients with blackouts, aiming to identify high risk, reduce misdiagnoses, reduce hospital admission rates for low-risk patients, diagnose and treat where appropriate, and also provide onward specialist referral. The majority of patients had syncope, and very few had epilepsy. A high proportion had an abnormal ECG. A specialist-nurse-led rapid access blackouts triage clinic (RABTC) provided rapid effective triage for risk, a comprehensive assessment format, direct treatment for many patients, and otherwise a prompt appropriate onward referral. Rapid assessment through a RABTC reduced re-admissions with blackouts. Widespread use of the web-based blackouts tool could provide the NHS with a performance map. The U.K. has low rates of pacing compared to Western Europe, which RABTCs might help correct. The RABTC sits between first responders and specialist referral, providing clinical assessment and ECG in all cases, and referral where appropriate.
短暂性意识丧失（T-LOC），又称晕厥，在急性医学中较为常见。临床技能不佳，仅在英国就有至少 74000 名患者被误诊和误治为癫痫。本研究旨在为晕厥患者提供快速、结构化的评估和心电图（ECG），旨在识别高危人群，减少误诊，降低低危患者的住院率，诊断和治疗适当的患者，并提供进一步的专科转诊。大多数患者有晕厥，极少数有癫痫。很大一部分患者的心电图异常。由护士主导的快速通道晕厥分诊诊所（RABTC）为风险提供了快速有效的分诊、全面的评估格式、对许多患者的直接治疗，以及及时适当的进一步转诊。通过 RABTC 进行快速评估可减少晕厥再入院率。广泛使用基于网络的晕厥工具可以为国民保健制度提供绩效图。与西欧相比，英国起搏率较低，RABTC 可能有助于纠正这一问题。RABTC 位于急救人员和专科转诊之间，在所有情况下都提供临床评估和心电图，并在适当情况下进行转诊。
