Accuracy of the initial diagnosis among patients with an acutely altered mental status

Emergency Medicine Journal : EMJ
Karl A SporerRobert Rodriguez

Abstract

The objectives of this prospective observational study were to: (1) determine the accuracy of physician diagnosis in patients with an acutely altered mental status (AMS) within the first 20 min of emergency department (ED) presentation; and (2) access if physician confidence in early diagnosis correlates with accuracy of diagnosis. A prospective observational convenience study was conducted of 112 adult patients who presented to an urban county ED with AMS (Glasgow Coma Scale (GCS) score ≤14) between August 2008 and July 2009. Within the first 20 min of patient presentation to the ED, treating physicians were asked to record their best diagnostic guess of the cause of the patient's AMS and their confidence in this diagnosis. Serial hourly GCS was performed and the results of all diagnostic testing were recorded. Blinded investigators determined the final consensus diagnostic cause of the patient's AMS. The final consensus diagnoses for AMS aetiologies were as follows: isolated alcohol intoxication 31%, other (psychotic episodes, underlying dementia) 21%, combination alcohol/other drug intoxications 18%, isolated other drug intoxications 10%, other metabolic derangements 6%, cerebrovascular accident/transient ischaemic attack 4%...Continue Reading

Citations

Jan 23, 2016·Archives of Gerontology and Geriatrics·Isadora BotwinickMelvin E Stone
Mar 19, 2014·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·Shahriar ZehtabchiArthur C Grant
Apr 29, 2014·Lancet·Jonathan A EdlowEelco F M Wijdicks
Feb 15, 2019·Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics
Apr 21, 2017·Der Nervenarzt·M BraunW U Schmidt
Jan 14, 2021·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Maximilian LutzWolf Ulrich Schmidt

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