J Neurocrit Care.  2023 Jun;16(1):10-17. 10.18700/jnc.230008.

The etiology and mortality of altered level of consciousness in the emergency room: before and after coronavirus disease

• Jeon Y
• Jeon JC
• Jung CG
• Kim KT

• KMID: 2543387
• DOI: http://doi.org/10.18700/jnc.230008

Abstract

Background
Coronavirus disease 2019 (COVID-19) has resulted in social, economic, medical, and psychological changes. New-onset altered level of consciousness (ALC) is a classical presentation in real-world medicine. This study investigated changes in ALC in the emergency room (ER) in the periods before (BC) and after (AC) COVID-19.
Methods
This was a retrospective study of patients with ALCs who visited the ER of a tertiary referral center, and their medical records BC and AC were compared. A consortium allocated and analyzed the etiologies of ALC in a case-by-case discussion. The time point for etiological assessment was the time of discharge from the ER.
Results
In total, 1,936 patients with ALCs (731 and 1,205 in BC and AC, respectively) were investigated. The most common etiology was systemic infection (25.9%), followed by metabolic causes (20.8%). Systemic infections (22.9% vs. 30.8%, P<0.001) and stroke (14.6% vs. 18.2%, P=0.037) were lower in AC than in BC, respectively, whereas rates of toxicity (15.4% vs. 6.0%, P<0.001) and traumatic brain injury (TBI; 5.9% vs. 0.8%, P<0.001) were higher in AC than in BC. The overall mortality rate of ALC in the ER was 18.5%.
Conclusion
This study demonstrated that the major etiologies of ALC in the ER were extra-cranial (58.5%). The mortality of ALC in the ER and the incidence of toxic cause and TBI increased in AC, suggesting a change in medical circumstances after the Pandemic.

Keyword

Consciousness disorders; Neurologic manifestations; Emergency medical services; Emergency room

Figure

• 

  Fig. 1. Flow diagram for disposition of patients with altered level of consciousness before (BC) and after (AC) coronavirus disease 2019. ER, emergency room; ALC, altered level of consciousness; GW, general ward; ICU, intensive care unit.

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  Fig. 2. Pie graph for etiology of altered level of consciousness in patients (A) before and (B) after coronavirus disease 2019 (COVID-19). CNS, central nervous system; TBI, traumatic brain injury; C&V, cardiogenic and vascular cause.

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