ETIOLOGICAL DETERMINANTS OF ALTERED MENTAL STATUS IN MEDICAL EMERGENCIES: A TERTIARY CARE HOSPITAL-BASED CROSS-SECTIONAL STUDY

Abstract

Introduction: Altered mental status (AMS) encompasses a range of clinical symptoms, not a
specific diagnosis. These symptoms include cognitive disorders, attention disorders, arousal
disorders, and decreased levels of consciousness. AMS is a commonly observed condition in the emergency department, especially among older adults. However, the term is not specific and is known by various names, such as lethargy, disorientation, and altered behavior.
Materials and Methods: A cross-sectional observational study was conducted from January to
December 2022 at Eeshan Hospital's Department of General Medicine in Hyderabad, Telangana. All adult patients presenting with AMS were enrolled and screened. AMS criteria included any of the following: a Glasgow Coma Scale (GCS) score below 15, RASS readings other than 0, inappropriate behavior, or hallucinations. Excluded were: a) patients readmitted with the same symptoms during the study and had previously been enrolled, and b) known dementia or irreversible brain damage cases.
Results: 67 patients with AMS were enrolled from January to December 2022. They were
prospectively evaluated two weeks after admission. The mean age was 49.76 ± 18.72 years
(range 18 - 91 years). Of these, 39 (58.20%) had at least one co-morbid condition.Hypertension
was the most common, followed by diabetes mellitus and chronic liver disease. Diabetes mellitus patients had a poorer prognosis compared to others (P < 0.037). Additionally, 20 patients (34.2%) consumed alcohol, six (11.9%) used tobacco in smoked or chewable forms, and three (5%) took opium derivatives. Three patients (5%) had a suspected poisoning history.
Conclusion: AMS presentations vary, with aetiologies spanning primary CNS causes and
systemic conditions leading to secondary AMS. Meningoencephalitis has a more favorable
outcome than strokes for primary AMS, while poisoning-related cases tend to fare better among secondary AMS cases. Relying on subjective AMS descriptions could be more optimal.
Standardized scoring systems can provide uniform assessments and insights into prognosis.
Dedicated objective tools tailored for emergency scenarios are needed.