The etiology and prognosis of non-traumatic impaired consciousness in patients admitted to the emergency department: a prospective cohort study

Abstract

Background and aim Altered level of consciousness(LOC) is a common complaint in patients admitted to the emergency department(ED). Altered LOC occurs with various causes. Emergent diagnosis and treatment of patients with altered LOC are vital to prevent irreversible brain damage. In this study, we aimed to acquire a better vision of non-traumatic altered LOC’s prevalent etiologies. The association between patients’ initial condition and survival was also assessed. Methods This prospective cohort study enrolled 1000 patients with altered LOC referred to two tertiary hospitals in 2020 and 2021. Patients with ALOC who had GCS < 14, and a final diagnosis, were included and followed for a month. We also collected all initial data gathered by ED triage and investigated the association of these entities with survival and their distribution among different final diagnoses. Results We studied 1000 patients. 52.4% of the population consisted of males. The mean age was 59.85 ± 16.06. Sepsis(38.3%) was the most common etiology, followed by: stroke(9.2%), heart failure(8%), myocardial infarction(7.3%), meningitis(7.2%), hepatic encephalopathy(6.5%) and alcohol intoxication(5.8%). Deceased patients had higher pulse rates(P = .030) and lower blood glucose(P = .049) and blood pressure(P = .001) at admission. Prior history of stroke(P = .003) and hyperlipidemia(P = .012) were associated with reduced survival odds. Conclusion Our data reveal high one-month mortality(56%) in patients with altered LOC. Also, patients with hyperlipidemia and a history of previous stroke seem to have worse outcomes. Due to this high mortality rate, patients with altered LOC should be treated intensively and prioritized, especially in crowded EDs.