Analysis of Patients with Altered Mental Status in an Emergency Department of Eastern Taiwan

Pei-Fang Lai ^a, Giou-Teng Yiang ^{a, b}, Ming-Jen Tsai ^a, Sheng-Chuan Hu ^{a, b}

^aDepartment of Emergency Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
^bInstitute of Medical Science, Tzu Chi University, Hualien, Taiwan

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Abstract

Objective
The purpose of this study was to determine the etiologies of altered mental status (AMS) in an emergency department (ED) and the associated contributing factors.
Materials and Methods
A retrospective chart review of the medical records was performed from January 2006 through December 2006 in a medical center in eastern Taiwan among the ED patients with AMS. Data collected included sex, age, date of ED visit, chief complaint, disposition, admission diagnosis, date of admission, location admitted to (ordinary ward or intensive care unit), diagnosis at discharge, and date of discharge from hospital.
Results
Of the 595 patients analyzed during the study period, which accounted for 1.3% of total ED census, the mean age was 51.55 years. The three leading etiologies of AMS were trauma, hypoglycemia, and stroke. Among them, trauma had higher incidences in the summer and winter; hypoglycemia had increased tendencies in the spring; the population of stroke patients increased in the summer and fall. Of the cases studied, 51.3% were admitted with a mean length of stay of 13.54 days; incidence of death was 12.4%. Other conditions with admission rate > 50% were hypoxia and stroke. The diagnoses with the lowest admission rate were psychosis, trauma and alcohol abuse. One third of AMS patients was younger than 40 years and the other one third was older than 70 years
Conclusion
It is important for ED physicians to be knowledgeable about the etiologies of patients with AMS in general, special subgroups, and the etiologic tendencies during the different seasons. Ranking results for the different etiologies of AMS in our study differed from the results of previous studies due to differences of local culture and residents in eastern Taiwan.

Keywords

Altered mental status (AMS); Coma; Confuse; Emergency department (ED)