Aetiologic Profile of Patients with Altered Mental Status in Medical Emergency in a Tertiary Care Medical Institute - A Cross Sectional Observational Study

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 = 24; 20 %), infections (N = 40; 33 %), metabolic (N = 37; 30.8 %), toxicologic (11; 9.2 %) and seizure disorder (N = 8; 6.7 %). The total mortality rate was 38 % as assessed at the end of two weeks. While RASS did not fare well as a prognostic tool, GCS score less than 8 was associated with statistically significant increase in mortality rates (52 % vs. 31 %). CONCLUSIONS Altered mental status has varied presentation and the aetiologies for AMS are evenly distributed among primary central nervous system (CNS) causes and systemic causes leading to secondary AMS. It is helpful to use some standardised scoring systems that bring uniformity in the assessment as well as prognostic implications. KEYWORDS Alerted Mental Status, Aetiologic Distribution, Outcome, RASS, GCS