Clinical Characteristics, Aetiologies, and Disposition Outcomes of Patients Presenting with Altered Mental Status in an Academic Emergency Department

To assess the clinical characteristics, aetiologies, and disposition outcomes of patients presenting with altered mental status (AMS) in an academic emergency department, as well as to explore factors associated with hospitalization, intubation, and mortality.

This retrospective cross-sectional study included 142 AMS patients presenting to the Emergency Department of (Blinded for Review) between December 2019 and December 2022. Adults (≥18 years) with documented AMS were enrolled, excluding those who died upon arrival or with iatrogenic AMS. Demographic, clinical presentation, comorbidity, medication, aetiology, intervention, and disposition outcome data, were extracted from the electronic System for Integrated Health Information.

The cohort (N = 142, mean age of 44.7 ± 21.1 years) was predominantly male (58.5%), and 83.1% of patients developed symptoms within 1 hour. Chronic comorbidities included diabetes (28.9%) and hypertension (28.2%), with frequent use of antihypertensives (23.2%), insulin (17.6%), and anticonvulsants (18.3%). Aetiologies were neurological (24.6%), drug abuse (24.6%), cardiovascular (15.5%), and endocrine/metabolic (12.0%). Most patients were discharged (81.7%), but the mortality rate was 4.2%. Intubation rate was 5.6%, of which intubation was primarily for traumatic AMS patients (37.5%), and all the intubated patients were male (p = 0.021). Males accounted for 83.3% of fatalities.

The present study identified key AMS patterns, including high-risk aetiologies (cardiovascular and traumatic) and male-dominated disparities (intubation and mortality). These findings advocate for aetiology-specific protocols and reassessment of potential sex biases in acute care.