Original ContributionsAltered mental status: Evaluation and etiology in the ED*,**
Section snippets
Methods
This study used a convenience sample design with a prospective identification of patients with AMS followed by a retrospective review of the medical records and retrospective determination of the diagnostic strength of the various aspects of the ED evaluation. Participants were patients with AMS prospectively identified by the attending EP in a university hospital ED with an annual census of 60,000 persons. The study was conducted over a period of 4 months. Three ED attending physicians
Results
Three hundred seventeen patients were entered in the study and represent the sample used for data analysis. This number of study patients represented 5% of the total ED census for these clinical shifts. The mean age of the study patients was 49 years with 57% male gender; refer to Figure 1 for a graphical depiction of the frequency of age occurrence in the study population.Of note, 10% of these patients had unknown identity on
Discussion
In the ED, the emergency physician encounters patients with AMS resulting from a range of etiologies involving both primary CNS events as well as secondary processes with an effect on the CNS. Examples of the 2 situations include acute ischemic stroke (the primary CNS event) and urosepsis with significant hypoperfusion (secondary [non-CNS] event with a depressive effect on the CNS). As noted previously, the medical literature provides little information regarding the possible etiologies
Conclusion
Patients presenting to the ED with AMS represent a small but significant percentage of the total patients evaluated; these patients require significant resource utilization by the ED. The combined knowledge of the most frequent causes of AMS and the most useful diagnostic tools in the evaluation of AMS can assist the EP in the management of these demanding and potentially ill patients.
References (10)
- et al.
Acute cognitive impairment in elderly ED patients: Etiologies and outcomes
Am J Emerg Med
(1996) - et al.
Patients of unknown identity: A neurodiagnostic challenge
Am J Emerg Med
(1994) - et al.
The John Doe syndrome: Diagnosis and outcome of patients identified at the time of emergency department admission
Am J Emerg Med
(1992) - et al.
Coma and depressed level of consciousness
- et al.
Differential diagnosis of dementia, delirium and depression: Implication for drug therapy
Drugs Aging
(1994)
Cited by (141)
Measurement of level of consciousness by AVPU scale assessment system based on automated video and speech recognition technology
2023, American Journal of Emergency MedicineAgitation in the Trauma Bay Is an Early Indicator of Hemorrhagic Shock
2023, Journal of Surgical ResearchApproach to Altered Mental Status and Inpatient Delirium
2022, Neurologic ClinicsNeurological Emergencies in Geriatric Patients
2022, Emergency Imaging of At-Risk Patients: General Principles