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Altered mental status: evaluation and etiology in the ED
William Kanich1, William J Brady, J Stephen Huff
1Department of Emergency Medicine, University of Virginia, Charlottesville, VA, USA.
The American Journal of Emergency Medicine
|November 21, 2002
Summary
Altered mental status (AMS) in the emergency department (ED) is often caused by neurologic and toxicologic issues. Patient history and physical exams are key diagnostic tools, while many tests have limited value.
Area of Science:
- Emergency Medicine
- Neurology
- Toxicology
Background:
- Altered mental status (AMS) is a common and complex presentation in emergency departments (EDs).
- Identifying the underlying causes and optimizing diagnostic strategies are crucial for effective patient management and resource allocation.
Purpose of the Study:
- To determine the etiologies of AMS in an ED population.
- To evaluate the diagnostic value of clinical evaluation features for AMS.
- To examine patient outcomes associated with AMS in the ED.
Main Methods:
- Prospective identification of patients with AMS in an ED.
- Retrospective review of medical records for 317 patients.
- Analysis of clinical evaluation features and diagnostic yield.
Main Results:
- Neurologic (28%) and toxicologic (21%) causes were most common for AMS.
- Patient history (51%) and physical examination (41%) showed the highest diagnostic value.
- Ancillary investigations like lab studies and ECG had limited diagnostic utility.
Conclusions:
- Neurologic, toxicologic, traumatic, and psychiatric syndromes are frequent causes of AMS in the ED.
- Clinical history and physical examination are paramount for diagnosing AMS.
- Despite representing a small fraction of ED visits, patients with AMS incur high resource use, admission rates, and mortality.