J Korean Neurol Assoc.  2021 Aug;39(3):141-149. 10.17340/jkna.2021.3.5.

The Etiologies of Altered Level of Consciousness in the Emergency Department: Before versus after Coronavirus Disease-19

• Kim DH
• Jeon JC
• Kim IC
• Kim Y
• Cho YW
• Kim KT

• KMID: 2518931
• DOI: http://doi.org/10.17340/jkna.2021.3.5

Abstract

Background
Altered level of consciousness (ALC) is a challenging condition in the emergency department (ED). We evaluated the clinical characteristics, causes, and prognosis of adult patients presenting with ALC at an ED of a university hospital.
Methods
The medical records of patients with ALC who visited the ED of a university hospital from February 2019 to November 2020 were reviewed to compare before and after the outbreak of coronavirus disease-19 (COVID-19) in Daegu, South Korea. The cause of ALC, its classification, the patients’ destinations, and prognosis were carefully decided and compared.
Results
A total of 1,851 patients with ALC in ED consisted of 1,068 before COVID-19 (BC; to February 17th, 2020) and 783 after COVID-19 (AC; from February 18th, 2020) were investigated. The all-time leading cause of ALC in ED was systemic infection (29.2% in BC, 25.0% in AC), followed by metabolic cause (21.0%) in BC and stroke (18.4%) in AC. Extra-cerebral etiologies of ALC were 1,206 (65.1%). The overall mortality of ALC in ED was 12.3%, consisting of 11.0% in BC and 14.2% in AC. During the daytime (07:00 to 18:59), patients in overall 1,179 patients (63.7%) with ALC visited ED, consisted of 665 (62.3%) in BC and 514 (65.5%) in AC.
Conclusions
This study demonstrated the extra-cerebral etiologies as the major causes of ALC in the ED. And there have been shifts in the etiology of ALC in ED.

Keyword

Consciousness disorders; Neurologic manifestations; Emergency medical services; Emergency medicine; COVID-19