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Up to half the UK population will faint or have a blackout at some point in their lives. Where a person spontaneously passes out but makes a full recovery afterwards, this is referred to as a transient loss of consciousness.

Accurate diagnosis of the underlying cause of a blackout is often problematic. People may also be seen by a range of clinicians and there is a great deal of variation in management of the condition.

NICE has published a new quality standard to ensure that people who have had a transient loss of consciousness receive a correct diagnosis quickly, efficiently and cost effectively.

The most common cause of a transient loss of consciousness is an underlying heart disorder but it can also be caused by disorders affecting the nervous system or psychological triggers.

Blackouts are particularly common in over 65s, where over a fifth (23%) will experience them due to low blood supply to the brain. In younger people, blackouts are usually due to an overreaction to certain triggers, for instance the sight of blood. It is thought that many younger people do not seek medical help, so the true incidence of blackouts may be greater than estimated.

Nick Baillie, quality standards programme director for NICE, said: “People often do not feel they need to seek help if they have fainted or had a blackout especially if they feel fine afterwards. However blackouts can be the sign of a more serious underlying condition, such as a heart disorder. This new quality standard sets out how healthcare professionals should assess any person who is suspected of having a transient loss of consciousness and which tests to use to correctly assess their condition and offer appropriate treatment.”

The quality standard includes 6 statements aimed at first line staff such as paramedics or accident and emergency staff, as well as healthcare professionals in primary and secondary care and healthcare commissioners.

The first statement stresses that if a person has had a suspected transient loss of consciousness, a detailed history and information about the event should be recorded as soon as possible. Anyone who witnessed the blackout should be spoken to. This initial assessment should also include recording a clinical history and physical examination.

Other statements cover priorities for healthcare professionals when assessing transient loss of consciousness and advice to people seeking medical help after a blackout:

• Healthcare professionals should use a 12-lead electrocardiogram (ECG)2during initial assessment to identify the likely cause.
• Healthcare professionals should not routinely use an electroencephalogram (EEG)3 to assess the underlying cause unless epilepsy is suspected.
• If a person also has 1 or more ‘red flag’ signs or symptoms identified such as breathlessness, fainting during exertion or a history of heart disorder, they should have cardiovascular assessment by a specialist team within 24 hours of their initial assessment.
• People are advised not to drive while they are awaiting specialist assessment.

The full standard can be viewed online at /guidance/QS71.

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

About the quality standard

1. Transient loss of consciousness is defined as spontaneous loss of consciousness with complete recovery. Complete recovery would involve full recovery of consciousness without any residual neurological deficit. An episode is often described as a ‘blackout’ or a ‘collapse’, but some people collapse without transient loss of consciousness.
2. A test that records the heart’s electrical signals, obtained by attaching electrodes in 10 standard positions on the limbs and the surface of the chest.
3. This is a test that records the brain’s electrical activity and is usually offered when epilepsy is suspected.
4. The quality standard is available at /guidance/QS71.

About NICE quality standards

NICE quality standards aim to help commissioners, health care professionals, social care and public health practitioners and service providers improve the quality of care that they deliver.

NICE quality standards are prioritised statements designed to drive measurable quality improvements within a particular area of health or care. There is an average of 6-8 statements in each quality standard.

Quality standards are derived from high quality evidence-based guidance, such as NICE guidance or guidance from NICE accredited sources, and are produced collaboratively with health care professionals, social care and public health practitioners, along with their partner organisations, patients, carers and service users.

NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health care professionals and social care and public health practitioners can use quality standards to help deliver high quality care and treatment.

NICE quality standards are not requirements or targets, but the health and social care system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

Quality standard topics are formally referred to NICE by NHS England (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for areas such as social care and public health.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.

To find out more about what we do, visit our website:www.nice.org.uk and follow us on Twitter: @NICEComms.