Altered mental status in the emergency department, a retrospective analysis

Abstract

Background: Altered mental status (AMS) is a common presentation of patients to the emergency department (ED), posing a significant challenge for the physician to accurately diagnose and begin appropriate management. The etiology of AMS spans a wide variety of clinical syndromes and is not consistent in all countries and regions. Materials and Methods: This was a retrospective analysis of 407 patients presenting to the ED with AMS in the months of January 2013 to April 2013. The details of the presentation, investigations, final diagnosis, and management were extracted from charts in the hospital electronic database. Results: AMS constituted 2.8% of patients registered at the ED during the study period. Of the 407 patients, 254 (62.3%) were male, and 153 (37.5%) were female. Mean age was 52.34 ± 17.84 years. Majority (n = 287; 70.4%) of the patients were in the age group between 18-64 years. Etiological factors were neurological (n = 151; 37.1%), metabolic/endocrine (n = 75; 18.4%), infections (n = 55; 13.5%) system/organ dysfunction (n = 49; 12%), toxicological (n = 39; 9.6%), miscellaneous (n = 19; 4.7%), oncological (n = 12; 2.9%), and psychiatric (n = 7; 1.7%). About 17.9% had mild AMS, 47.4% had moderate AMS, and 34.6% had severe AMS. Majority (65.1%) presented to ED within 24 h of onset of AMS. Total mortality rate was 11.5% (n = 47). Conclusions: This study has conveyed the frequency of various etiologies of AMS and its stratification in regards to age and severity. Neurological conditions remain the most common cause of AMS. Data reveal a large fraction of patients presenting beyond 24 h of onset of AMS. Public education concerning the establishment of support systems for the vulnerable population can lead to faster presentation to the ED and subsequent management.