Mehmet Ali Aslaner1, Mustafa Boz2, Ali Çelik3, Asliddin Ahmedali4, Sercan Eroğlu5, Nalan Metin Aksu2, Serkan Emre Eroğlu3. 1. Nevsehir State Hospital, Emergency Department, Nevsehir, Turkey. Electronic address: maliaslaner@hotmail.com. 2. Hacettepe University Faculty of Medicine, Emergency Medicine, Ankara, Turkey. 3. Marmara University Pendik Research and Training Hospital, Emergency Medicine, İstanbul, Turkey. 4. Nevsehir State Hospital, Emergency Department, Nevsehir, Turkey. 5. Ahi Evran University Training and Research Hospital, Emergency Department, Kırsehir, Turkey.
Abstract
OBJECTIVES: Altered mental status (AMS) is a challenging diagnosis in older patients and has a large range of etiologies. The aim of this study was to investigate the nature of such etiologies for physicians to be better aware of AMS backgrounds and hence improve outcomes and mortality rates. METHODS: This prospective observational study was conducted at 4 emergency departments. Patients 65 years and older who presented to the emergency department with acute AMS (≤1 week), with symptoms ranging from comas and combativeness, were eligible for inclusion in this study. The outcomes, etiologies, Richmond Agitation and Sedation Scale scores, and the presence of delirium were recorded. RESULTS: Among 822 older patients with AMS, infection (39.5%) and neurological diseases (36.5%) were the most common etiologies. The hospital admission and mortality rates were 73.7% (n = 606) and 24.7% (n = 203), respectively. The mortality rate rose if AMS persisted for more than 3 days. Delirium was observed in 55.7% of the patients; these individuals had higher durations of AMS than those without delirium (median, 24 hours; interquartile range, 3-48 hours; median 6 hours, interquartile range, 3-48 hours, respectively; P = .010). Notably, delirium was observed in more than two-thirds of neurological patients. CONCLUSIONS: The most common causes of AMS were infection and neurological diseases. Delirium was associated with AMS in nearly half the patients. Moreover, the rates of hospitalization and mortality remained high.
OBJECTIVES: Altered mental status (AMS) is a challenging diagnosis in older patients and has a large range of etiologies. The aim of this study was to investigate the nature of such etiologies for physicians to be better aware of AMS backgrounds and hence improve outcomes and mortality rates. METHODS: This prospective observational study was conducted at 4 emergency departments. Patients 65 years and older who presented to the emergency department with acute AMS (≤1 week), with symptoms ranging from comas and combativeness, were eligible for inclusion in this study. The outcomes, etiologies, Richmond Agitation and Sedation Scale scores, and the presence of delirium were recorded. RESULTS: Among 822 older patients with AMS, infection (39.5%) and neurological diseases (36.5%) were the most common etiologies. The hospital admission and mortality rates were 73.7% (n = 606) and 24.7% (n = 203), respectively. The mortality rate rose if AMS persisted for more than 3 days. Delirium was observed in 55.7% of the patients; these individuals had higher durations of AMS than those without delirium (median, 24 hours; interquartile range, 3-48 hours; median 6 hours, interquartile range, 3-48 hours, respectively; P = .010). Notably, delirium was observed in more than two-thirds of neurological patients. CONCLUSIONS: The most common causes of AMS were infection and neurological diseases. Delirium was associated with AMS in nearly half the patients. Moreover, the rates of hospitalization and mortality remained high.
Authors: Jessica A Stanich; Lucas Oliveira J E Silva; Alexander D Ginsburg; Aidan F Mullan; Molly M Jeffery; Fernanda Bellolio Journal: Am J Emerg Med Date: 2021-10-30 Impact factor: 4.093
Authors: Mats Warmerdam; Frank Stolwijk; Anjelica Boogert; Meera Sharma; Lisa Tetteroo; Jacinta Lucke; Simon Mooijaart; Annemieke Ansems; Laura Esteve Cuevas; Douwe Rijpsma; Bas de Groot Journal: PLoS One Date: 2017-09-25 Impact factor: 3.240
Authors: Bedriye Müge Sönmez; Murat Doğan İşcanlı; Selçuk Parlak; Yasin Doğan; Hilmi Gökhan Ulubay; Emirhan Temel Journal: Turk J Emerg Med Date: 2018-04-21
Authors: Ryan A Tesh; Haoqi Sun; Jin Jing; Mike Westmeijer; Anudeepthi Neelagiri; Subapriya Rajan; Parimala V Krishnamurthy; Pooja Sikka; Syed A Quadri; Michael J Leone; Luis Paixao; Ezhil Panneerselvam; Christine Eckhardt; Aaron F Struck; Peter W Kaplan; Oluwaseun Akeju; Daniel Jones; Eyal Y Kimchi; M Brandon Westover Journal: Crit Care Explor Date: 2022-01-18
Authors: Amy Todd; Samantha Blackley; Jennifer K Burton; David J Stott; E Wesley Ely; Zoë Tieges; Alasdair M J MacLullich; Susan D Shenkin Journal: BMC Geriatr Date: 2017-12-08 Impact factor: 3.921
Authors: Ashley Sanello; Marianne Gausche-Hill; William Mulkerin; Karl A Sporer; John F Brown; Kristi L Koenig; Eric M Rudnick; Angelo A Salvucci; Gregory H Gilbert Journal: West J Emerg Med Date: 2018-03-08