TOPLINE:

According to a cross-sectional study, altered mental status accounted for 3.1% of emergency department (ED) visits in the US, and the most common discharge diagnosis was nonspecific symptoms or signs (syndromic diagnosis).

METHODOLOGY:

• Researchers conducted a cross-sectional cohort study of 4256 adults (mean age, 50 years; 56.5% men; 63.4% non-Hispanic White individuals) who presented to the ED primarily for altered mental status, using 2016-2022 data from the National Hospital Ambulatory Medical Care Survey.
• Outcomes included visit frequency, clinical features, diagnostic testing (head CT or MRI), ED disposition, and discharge diagnoses.
• The exploratory outcome was the proportion of patients diagnosed with stroke or transient ischemic attack.

TAKEAWAY:

• ED visits for altered mental status accounted for 3.1% of all visits, corresponding to approximately 4.5 million visits annually in the US, and 60.3% of patients arrived by ambulance. Notable comorbidities included substance abuse in 24.1% of patients, alcohol abuse in 27.9%, and depression in 31.3%.
• Head CT was performed in 29.2% of visits, whereas MRI was performed in only 2.0% of visits. Diagnostic services were ordered or provided in 61.7% of visits, and specialist consultation was sought in 22.3%. The mean length of stay in the ED was 458 minutes.
• The most common ED discharge diagnoses were nonspecific symptoms or signs (syndromic diagnosis) in 27.1% of patients, followed by psychiatric conditions in 26.0%, injury-related diagnoses in 13.0%, and neurologic diseases in 4.9%.
• Stroke/transient ischemic attack was an ED discharge diagnosis in 2.3% of patients and the primary inpatient discharge diagnosis in 1.3%. Among hospitalized patients with a syndromic diagnosis at ED discharge, 37% maintained a syndromic diagnosis at discharge; deaths in the ED were rare (1.2%).

IN PRACTICE:

"AMS [altered mental status] presentations accounted for 1 in 30 ED visits and were characterized by substantial diagnostic uncertainty as reflected in the assignment of syndromic diagnoses. Improved diagnostic strategies for patients with AMS may be warranted," the authors wrote.

SOURCE:

The study was led by Vera Pertsovskaya, MD, Feil Family Brain & Mind Research Institute, Weill Cornell Medicine, New York. It was published online on November 01 in The American Journal of Emergency Medicine.

LIMITATIONS:

The National Hospital Ambulatory Medical Care Survey dataset relies on administrative coding and structured abstraction, which may have led to the misclassification of symptoms and diagnoses. The dataset lacks detailed clinical information such as physical examination findings and standardized test scores. The system used for grouping diagnostic codes may not have fully captured nuanced diagnoses, particularly for overlapping conditions. Additionally, the varying interpretations of altered mental status across different healthcare settings may have limited the generalizability of the findings.

DISCLOSURES:

Funding information was not provided for this study. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.