Home » Why set up a T-LoC Clinic?

Improving Patient Care

RATC – Improving patient care:

  • A patient presenting at A&E/ER with an unexplained blackout/T-LoC who is referred to the RATC could see the team within days of their episode
  • Encouraging GPs and A&E/ER departments to refer blackout/T-LoC patients directly to an RATC as an automatic follow up offers immense reassurance to patients
  • The RATC provides a valuable filtering process for patients who present with blackouts/T-LoCs and are hard to diagnose
  • The multi-disciplinary setting allows for a patient to be assessed without any presuppositions and reduces the risk of misdiagnosis

Effects of Misdiagnosis:

  • The misdiagnosis and delayed diagnosis in patients who suffer blackouts/T-LoCs that are in fact triggered by cardiovascular irregularities is a common and costly occurrence. Many doctors instinctively assume that blackouts/T-LoCs are likely to be due to epilepsy (or want to “exclude” this, as the most important implication of a blackout/T-LoC), but in fact syncope accounts for most blackouts/T-LoCs, of which the majority are cases of Reflex Syncope, with up to 50% of people suffering Reflex Syncope during their lives1,2
  • Misdiagnosis of epilepsy damages patients’ lives and can be very dangerous; in certain cases it has led to tragic deaths in young people, after wrong treatment with anti-convulsant drugs
  • Patients who receive a delayed diagnosis also suffer - they are often admitted to hospital to undergo expensive and repeated investigations, many of which do not provide a definite diagnosis. For the patient, life continues to be restricted by their blackouts/T-LoCs
  • A diagnosis of epilepsy can have a huge impact on the life of a patient because of its potential impact on employment prospects, driving and the social stigma associated with the condition. Medication prescribed to treat epilepsy often causes mood swings or weight gain, and can ultimately affect confidence
  • Once a “label” of epilepsy has been given it is very difficult to remove, because of a lack of good tests for alternative diagnoses
  • Over 70% of sufferers of syncope endure depression or anxiety because of their attacks, and a similar number alter their daily activities to avoid the risk of suffering a blackout/T-LoC in embarrassing or dangerous circumstances2
  • The high incidence of misdiagnosis and delays to diagnosis also means that arrhythmias are severely under-treated. This is of particular concern for certain types of serious arrhythmia that can lead to sudden cardiac death (SCD)3

References

  1. Petkar, S., Jackson, M., Fitzpatrick, A. Management of blackouts and misdiagnosis of epilepsy and falls. Royal College of Physicians Journal : vol 5 : September/October : Conference reports
  2. Sikverstein MD, Singer DE, Mulley AE, Chibault E, Barrett O. Patients with syncope admitted to medical intensive care units. JAMA 1982;248(10):1185-9.
  3. STARS http://www.stars.org.uk/patient-info/diagnosis/blackouts-checklist