Aetiologic Profile of Patients with Altered Mental Status in Medical Emergency in a Tertiary Care Medical Institute - A Cross Sectional Observational Study (original) (raw)
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Journal of Medical Science And clinical Research, 2019
Background: Evaluation of a patient with Altered Mental Status AMS in the Emergency department ED is difficult for many reasons. Emergency physician is usually expected to make q a correct working provisional diagnosis in AMS in quick time; and the accuracy of this provisional diagnosis has an important bearing sometimes on prognosis of patient Objective: The Aim of the study was to determine retrospectively the diagnostic accuracy in the Emergency Department and to determine diagnostic value of various components of clinical evaluation. Methods: The study was conducted prospectively in 201 patients who presented to a tertiary care hospital with AMS .Children, and patients with history of dementia, psychiatric disease, were excluded. History and examination was done, and provisional diagnosis made. CT scan head & CSF analysis were routinely done. All required investigations were done to reach the final diagnosis. Results: In 11.4% provisional diagnosis did not match with final diagnosis, in 16.4%, diagnosis matched partially, in 71.6 % diagnosis matched completely. The specific features of the clinical evaluation of diagnostic value followed by rates of positive diagnostic finding included:
Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care
The western journal of emergency medicine, 2018
In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluat...
Validation of a New Coma Scale, the FOUR Score, in the Emergency Department
Neurocritical Care, 2008
Objective Full Outline of Unresponsiveness (FOUR) score has previously been validated scale in the Neurosciences Intensive Care Unit. In this study, we sought to validate the use of FOUR score in the emergency department (ED) using non-neurology staff. We also compared its performance to the Glasgow Coma Scale (GCS) and correlated it to functional outcome at hospital discharge and overall survival. Methods We prospectively rated 69 patients with initial neurologic symptoms presenting to the ED. Three types of examiners performed the FOUR score: ED physician, ED resident, and ED nurse. Patients were followed through hospital discharge; functional outcome was measured using modified Rankin Score (mRS). Results Interrater reliability for FOUR score and GCS was excellent (respectively, j w = 0.88 and 0.86). Both FOUR score and GCS predicted functional outcome, and overall survival with and without adjustment for age, sex, and alertness group. Conclusion The FOUR score can be reliably used in the ED by non-neurology staff. Both FOUR score and GCS performed equally well, but the neurologic detail incorporated in the FOUR score makes it more useful in management and triage of patients.
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...
The Glasgow Coma Scale--a brief review. Past, present, future
Acta Neurologica Belgica, 2008
The Glasgow Coma Scale (GCS) was introduced in 1974 aiming at standardizing assessment of level of consciousness in head injured patients. It has been used mainly in evaluating prognosis, comparing different groups of patients and monitoring the neurological status. However, its use expanded beyond the original intention of the scale and certain limitations were identified. The skewness toward the motor subscore, the experience of the raters, the process of intubation, the time and setting of rating among others are to be taken into account. In this review a thorough presentation of this scale's history, principles of scoring and associated common pitfalls, major applications and drawbacks is attempted. Moreover, future trends and implications are considered. The key concept in all articles reviewed is that even though GCS is not a perfect tool and other coma scales have been proposed, it seems destined to be incorporated in clinical decisions regarding coma for many years to come. Nonetheless, deep knowledge of its proper applications on one hand and limitation of its misuse on the other is essential to benefit both health care professionals and their patients.
Assessment of Mental State — Selected Measuring Tools in Neurogeriatrics
The Journal of Neurological and Neurosurgical Nursing, 2017
Complete Cerebral Assessment (CGA) involves the assessment of a neurological patient in four basic areas where performance capacity, physical health, mental health, as well social and environmental factors are taken into account. Specially prepared research tools (scales, questionnaires) can be used to assess individual CGA components, which significantly facilitate it and influence its credibility. In addition, they allow to verify changes in patient's condition over time, in the category of improvement or deterioration, and also help in the exchange of quantitative (clinical) information between health care providers. Based on the literature, there have been discussed the most frequently applied scales used to assess the mental state of neurogeriatric patients. There have been presented data of metrics such as Mini-Mental State Examination (MMSE), Abbreviated Mental Test Score (AMTS), Clock Drawing Test
Application and Clinical Utility of the Glasgow Coma Scale Over Time
Journal of Head Trauma Rehabilitation, 2014
To examine possible changes in Glasgow Coma Scale (GCS) scores related to changes in emergency management, such as intubation and chemical paralysis, and the potential impact on outcome prediction. Participants: 10 228 patients from the Traumatic Brain Injury Model Systems national database. Design: Retrospective study examining 5-year epochs from 1987 to 2012. Main Measures: GCS score assessed in the Emergency Department (GCS scores for intubated, but not paralyzed, patients were estimated with a formula using 2 of the 3 GCS components), Outcome: Functional Independence Measure (FIM) assessed at rehabilitation admission. Results: The rate of intubation prior to GCS scoring averaged 43% and did not increase across time. However, a clear increase over time was observed in the use of paralytics or heavy sedatives, with 27% of patients receiving this intervention in the most recent epoch. Estimated GCS scores classified 69% of intubated patients as severely brain injured and 8% as mildly injured. The GCS accounted for a modest, yet consistent, amount of variability (approximately 5%-7%) in FIM scores during most epochs. Conclusions: Given the frequency of intubation and/or paralysis following brain injury in this sample, estimating GCS or exploring other means to gauge injury severity is beneficial, particularly because a portion likely did not sustain severe brain injury. There is no evidence for declining predictive utility of the GCS over time.
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. ...
European Journal of Emergency Medicine, 2009
The Glasgow Coma Scale (GCS) is the most widely used tool for the evaluation of the level of consciousness. The Full Outline of Unresponsiveness (FOUR) Score is a new coma Scale that was developed considering the limitations of the GCS, and has been found to be useful in an intensive care setting. We aimed to compare FOUR Score and GCS in the emergency setting. All patients older than 17 years who presented with an altered level of consciousness, after any trauma to the head or with neurological complaints were included in this study. Three-month mortality, in-hospital mortality, and poor outcome using a Modified Rankin Scale (MRS) of 3-6 points were used as the primary outcome measures. A total of 185 patients were included in the study. Area under the curve (AUC) values in predicting 3-month mortality for GCS was 0.726 [P=0.0001 and 95% confidence interval (CI): 0.656-0.789] and 0.776 (P=0.0001 and 95% CI: 0.709-834) for FOUR Score. AUC in predicting hospital mortality for GCS was 0.735 (P=0.0001 and 95% CI: 0.655-0.797) and 0.788 (P=0.0001 and 95% CI: 0.722-0.844) for FOUR Score. AUC in predicting poor outcome (Modified Rankin Scale: 3-6) was 0.720 (P=0.001 and 95% CI: 0.650-784) for GCS and 0.751 (P=0.0001 and 95% CI: 0.682-0.812) for FOUR Score. The new coma Scale, FOUR Score, is not superior to the GCS. However, the combination of the eye and motor components of FOUR Score is a valuable tool that can be used instead of either the FOUR Score or GCS.
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.