A Survey Study of Etiology of Altered Consciousness in the Emergency Department
Pornchai Sathirapanya MD*, Naris Smitasin MD*, Kitti Limapichart MD*, Suwanna Setthawatcharawanich MD*, Kanitpong Phabphal MD*
Affiliation : * Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Background : Altered consciousness (AC) is a common presenting problem in the Emergency Department
(ED), the causes of which can be either intracranial or extracranial in origin.
Objective : To determine the common etiologies of AC among patients in the ED of a medical teaching hospital
and to build up a proper differential diagnosis.
Material and Method: A retrospective review of the medical records of patients who presented with AC in the
ED between January and August 2004 was conducted. Patient characteristics and demographic data as well
as the etiologies of AC were presented in descriptive pattern.
Results : There were 350 patients, of whom 67 (19.1%) were admitted, 38(10.9%) were transferred to other
hospitals due to full occupancy, 35(10%) died in the ED, and the rest (60%) were discharged and re-evaluated.
The mean age was 60.3 years old with 57.1% males and 42.9% females. The etiologies included neurological
disorders (29.1%), endocrine/metabolic derangement (20.8%), infectious diseases and sepsis (18.8%),
cardiovascular disorders (10%), psychiatric illness (8.8%), pulmonary (7.1%), and toxicological causes
(5.1%).
Conclusion : Though neurological disorders or intracranial causes were the most common etiology of AC in
the ED, they accounted for only one-third of all cases in the ED. The larger proportion of AC cases was
extracranial abnormalities including adverse effects from current medications.
Keywords : Consciousness disorders, Emergency service, hospital, Emergency medical services
