Saraswati Kushwah1, Pritam Singh2, Kamal Singh3, Daljinderjit Kaur4, Sarabmeet Singh Lehl5
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.
