Altered Mental Status: Diagnostic value of various clinical parameters and diagnostic accuracy in emergency department (original) (raw)
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Journal of Evidence Based Medicine and Healthcare, 2021
BACKGROUND Altered mental status (AMS) is a symptom complex that may arise from a variety of primary neurologic disorders and systemic illnesses. The underlying diagnosis affects final outcome of patients that may be predicted by use of objective tools. This study was conducted to describe the aetiologic distribution of such patients presenting to emergency room and assess the utility of Richmond Agitation Sedation Scale (RASS) and Glasgow Coma Scale (GCS) as prognostic tools. METHODS In this cross-sectional observational study, we identified such 120 adult patients at a single centre tertiary care facility and documented their bio-demographic profile, RASS & GCS scores, routine metabolic profile, specific investigations (like neuro-imaging, lumbar puncture, toxicologic screen) as indicated, along with patient outcome at 2 weeks. RESULTS The mean age of patients was 49.76 ± 18.72 years with 79 (66 %) patients being male. The aetiologic distribution was as follows; cerebrovascular (N...
Bulletin of Clinical Psychopharmacology, 2015
The evaluation of mental status of elderly patients presenting to emergency services and the comparison between the last diagnosis and their complaints Introduction: The number of geriatric patients presenting to the emergency department increases every year. In addition, it is known that the mental status of geriatric patients may deteriorate as they age. In the emergency department, one of the main premises of patient management is anamnesis. However, impairments in mental status of geriatric patients decrease the reliability of anamnesis. In this study, we aimed to determine the mental status of elderly patients who presented to the emergency department, the relationship between mental status and patients' complaints, and last diagnoses and mortality. Materials and Methods: The study was planned to be prospective. The mental status of geriatric patients who presented to the emergency department was evaluated with a six-question screening test. Complaints, final diagnosis information, hospitalization department, duration of hospitalization, judicial status and mortality information were recorded. Consistency between patients' complaints and symptoms determined in physician examination was evaluated. Symptom-finding consistency levels based on mental status were compared. Kappa tests for consistency assessments and chi-square test for intergroup comparisons were used. Findings: The match between patient complaints and final diagnosis of 755 patients was evaluated by two independent specialist physicians. As a result of the six-question screening test, a mismatch between patient complaint and final diagnosis was found in 16.2% of 204 patients with abnormal screening tests (n=33) compared to 0.4% of 551 patients, who had a normal screening test (n=2). Mortality was found to be 9.8% in patients with abnormal test results while it was found to be 2.0% in patients with normal screening tests. Conclusion: Mental status variance determined in elderly patients appears to be a risk factor in terms of mortality. Complaints in geriatric patients having mental status variance can be deceptive in terms of pointing to the current disease. Exploring this relationship in detail with further studies should be considered, in order to make a significant contribution to the service provided to this patient group.
The bedside mental status examination--reliability and validity
1981
C LINICIANS who routinely administer serial sevens, memory tests, and proverb interpretations to assess higher intellectual functions must often wonder what meaning or practical value the results of these clinical tests have. Although the method of mental status examinations was organized by Adolph Meyer in 1902,' there has been surprisingly little systematic research to establish the value of such measures. Despite this lack of evidence, these tests remain widely used, not only by psychiatrists but by neurologists, internists, pediatricians, and others. Numerous medical specialty textbooks2-'o recommend them, yet fail to document the empirical basis for their use. In an earlier work" intended to develop a series of clinical examinations,12-'4 we describe many inadequacies in the assessment of mental status. To our knowledge, few individuals in clinical training anywhere, receive substantial introduction to the potential or limitation of these tests. This article focuses on the available evidence concerning the usefulness of tests of higher intellectual functioning. After discussing the purposes of such tests, we critically review the literature on higher intellectual function testing from the standpoint of the clinician; viz., how can the results of such tests be meaningfully applied to the individual case. The clinician's criteria for usefulness are, in a certain sense, more demanding than those of the researcher. The clinician needs to know what a particular score means for his patients. Individual rather than group prediction is a more stringent standard for tests of higher intellectual function, but one which they must meet in order to be relevant to daily clinical concerns. While a small but significant difference between groups of patients on a particular variable may be a viable finding for research purposes, for the clinician, knowledge of a meaningful cutoff score indicating high probability for the absence or presence of organic mental disorder is equally important. In this sense, reliability and validity of the tests of higher intellectual functioning become specific concerns for the clinician, and a major part of this critical survey. We will make a distinction between organic brain disease and functional psychiatric disorders. This maintains the convention used in most classification systems of mental disorders.'5,'6 It is necessary to stress, as in the Diagnostic and Statistical Manual of Mental Disorders III (DSM), that "differentiation of organic mental disorders are independent of brain processes." We assume
International Journal of Advances in Medicine
Background: Authors conducted this study to find the profile of causes and diseases that affect patients of younger age group in altered sensorium admitted in a general hospital associated with Government Medical College Srinagar, in India.Methods: Authors conducted present study over a period of eight months. The patients of young and middle age who were admitted in their hospital ward with altered mental status were included. The study subjects were divided into two groups: group A included patients of age upto 30 years, and group B with patients in age group 31-50 years. The patients were studied for their diagnoses, comorbidities, gender distribution, duration of stay in hospital and mortality patterns.Results: Authors had a total of 112 patients of young and middle age admitted in their hospital ward with altered mental status during the study period. In group A, there were 42 patients or 37.5% (20 males and 22 females). In group B, there were 70 patients or 62.5% (30 males and...
Management of altered mental status
Pediatric Dental Journal, 2010
Altered mental status (AMS) is a symptom complex that has various causes and treatments, many of which require timely intervention. Hyperventilation as a component of panic attack may give rise to AMS as it causes a chemical imbalance in the blood. Pediatric dentists must be able to recognize symptoms of AMS which result from hyperventilation and panic attacks and be able to differentiate them from hypoglycemia or diabetic ketoacidosis which may be exhibited in children with both panic attacks and diabetes mellitus. A panic attack is defined as a period of intense fear or discomfort, in which of four or more of the following symptoms develop and reach a peak within 10 minutes 9). z Palpitations, pounding heart, or accelerated heart rate z Sweating z Trembling or shaking z Sensation of shortness of breath or smothering z Feeling of choking z Chest pain or discomfort z Nausea or abdominal distress z Feeling dizzy, unsteady, light headed, or faint z Derealisation (feelings of unreality) or depersonalisation (being detached from oneself) z Fear of losing control or going crazy z Fear of dying z Parasthesis (numbness or tingling sensations) z Chills or hot flushes Panic disorder is defined as the presence of recurrent, unexpected panic attacks followed by at least 1 month of persistent concern about having another panic attack, worry about the possible implications or consequences of the attacks, or a significant behavioral change related to the attacks 9). The presentation of hyperventilation during a panic attack may mimic either hypoglycemia or diabetic ketoacidosis, making the diagnosis very
Undiagnosed Mental Illness in the Emergency Department
The Journal of Emergency Medicine, 2012
Background: Mental illness affects 8% of the population. The early identification and treatment of mental illness can reduce the progression and complications of the illness. Objective: The objective of this study was to identify unsuspected psychiatric illness in patients presenting to the emergency department (ED) with non-psychiatric-related complaints. A comparison of the test results and the emergency physician assessments were then compared. Methods: All consenting and stable patients who presented to the ED with non-psychiatric complaints were given the Mini-International Neuropsychiatric Interview (MINI). It was administered to the patient by a trained research fellow before the patient was seen by the physician. Before the patient's departure from the ED, the research fellow notified the emergency physician of the results of the MINI interview. After the emergency physician was notified of the diagnosis of the MINI, any change in the treatment was reviewed. Results: A total of 211 patients were enrolled in the study. The majority of patients (55%) tested negative for all undiagnosed mental illnesses. The top diagnoses were as follows: major depression (24%), general anxiety (9%), and drug abuse (8%). Of all those patients who tested positive for an undiagnosed mental illness, only 2% were diagnosed by the ED attending. Conclusions: The idea that the ED is a good place to identify undiagnosed mental health illnesses was confirmed. The use of an independent test such as the MINI was also shown to be useful to aid the emergency physician in identifying undetected mental illnesses. Ó 2012 Elsevier Inc.
ELDERLY PATIENTS WITH ALTERED MENTAL STATUS
Emergency Medicine Clinics of North America, 1998
Mental status changes in the elderly are a source of concern and a challenge for the emergency physician. A variety of medical conditions and psychiatric disturbances are potential causes of those symptoms. Acute changes must be differentiated from mental status alterations occurring as a result of chronic conditions. This article focuses on the emergency evaluation, treatment, and differential diagnosis of this symptom complex.
JPMA. The Journal of the Pakistan Medical Association, 2014
To evaluate the value of electroencephalography in patients with altered mental status in emergency departments. Demographical characteristics, types and aetiologies of seizures, and clinical outcomes of the patients were recorded. Patients were divided into 4 groups according to the complaints of admission: findings and symptoms of seizure; stroke and symptoms of stroke-related seizures; syncope; and metabolic abnormalities and other causes of altered mental status. The electroencephalography findings were classified into 3 groups: epileptiform discharges; paroxysmal electroencephalography abnormalities; and background slowing. Electroencephalography abnormalities in each subgroup were evaluated. SPSS 21 was used for statistical analysis. Of the total 190 patients in the study, 117 (61.6%) had pathological electroencephalography findings. The main reason for electroencephalography in the emergency department was the presence of seizure findings and symptoms in 98 (51.6%) patients. ...
Academic Emergency Medicine, 2002
Objective: In order to increase the utility of the Quick Confusion Scale (QCS), a six-item, 15-point instrument used in screening for impaired mental status in an emergency department (ED) setting, clinical norms were established for an ED patient population. Methods: The QCS was administered to ED patients of a universitybased hospital during a nine-week period. All subjects scoring less than 15 on the QCS were also administered the Mini-Mental State Examination (MMSE); 731 patients provided QCS scores for use in this study and 295 provided MMSE scores in addition to their QCS scores. Results: The internal consistency of the QCS was found to be within acceptable limits given that the briefness of the scale forced restriction in the variability coefficient. QCS scores were converted to a standardized metric (percentile ranks), population parameters were consulted, and two cutoff scores were established: one that suggests the likelihood of a cognitive impairment, signaling a need for further evaluation (QCS score of 11); and one that indicates an almost certain cognitive impairment (QCS score of 7). Percentile rank comparisons between subjects' scores on the MMSE and on the QCS provided additional validity for the cutoff scores. Conclusions: The QCS, in its focus on providing a quickly obtained, easily calculated, and readily interpreted score, presents a viable alternative to currently existing practices for assessing mental status in ED patients.