J Korean Soc Emerg Med.  2024 Aug;35(4):309-320.

The etiologies in patients with altered mental status transported by the emergency medical services

• Yeo HD
• Park JY
• Ahn SJ
• Kim YH

Abstract

Objective
There is insufficient data on the etiology of altered mental status (AMS). This study aimed to classify the causes of AMS in patients transported by the 119 emergency medical services (EMS) and analyze the characteristics of vital signs.
Methods
We enrolled patients with AMS based on the Glasgow Coma Scale (GCS) score <15, who were transferred to the emergency department by 119 EMS. The causes of AMS were determined through a retrospective review of their medical records.
Results
A total of 2,730 patients were enrolled. The major causes for AMS were stroke (19.9%), intoxication (17.7%), traumatic brain injury (9.6%), sepsis (6.4%), and seizures (6.3%). The proportion of non-central nervous system (non-CNS) causes was higher than CNS-related causes (72.4% vs. 27.6%, P<0.001). The proportion of patients with shock was 6.2%. Age >60 years (odds ratio [OR]=2.30; 95% confidence interval [CI], 1.77-3.00), female (OR=0.69; 95% CI, 0.55-0.87), GCS <9 (OR=1.96; 95% CI, 1.57-2.46), systolic blood pressure (SBP) <90 mmHg (OR=2.96; 95% CI, 2.04-4.29), SBP ≥180 mmHg (OR=1.73; 95% CI, 1.29-2.32), respiratory rate >20/min (OR=1.72; 95% CI, 1.34-2.20), saturation <94% (OR, 1.89; 95% CI, 1.46-2.44), body temperature >37.5
Conclusion
The etiologies of AMS in patients were varied. Non-CNS causes were more prevalent than CNS-related causes. Approximately 6% of patients met the criteria for shock.

Keyword

Consciousness disorders; Emergency medical services; Emergency medicine