Comparative etiological analysis of critical patients presenting to the emergency department with altered consciousness across age groups: A prospective observational study

Abstract

Introduction: The aim of our study is to assess the relationship between altered consciousness in patients presenting to the emergency department (ED) without a history of trauma and the physiological changes associated with aging. Additionally, we aim to compare diagnostic differences between patients under the age of 65 and those aged 65 and above. Methods: This prospective study was conducted at the ED of Uluda & gbreve; University Medical Faculty Hospital over a 1-year period from December 2012 to November 2013. Patients aged 18 and above presenting with non-traumatic altered consciousness were included, and they were categorized into two groups based on age: <65 years and >= 65 years. Comparison between age groups included gender, seasonal presentation, vital signs, consciousness level, Glasgow Coma Scale (GCS) score, requested consultations, diagnoses, and outcomes. Results: Out of 646 patients, 312 (48%) were female, and 334 (52%) were male, with a mean age of 64.9 +/- 16.4 years. The highest number of admissions for altered consciousness occurred during the summer season (n = 200, 31%). In the 65 and above age group, a statistically significant elevation was found in the mean systolic blood pressure (p < 0.05). In neurological diagnoses, cerebrovascular events were observed most frequently, while in non-neurological diagnoses, endocrine/metabolic diseases were more common. It was observed that GCS scores were lower in neurological diagnoses (p = 0.020). Discharges were more frequent in the under 65 age group, with a statistically significant difference (p < 0.05). It was found that the mortality rate was higher in non-neurological diagnoses, and this was statistically significant (p < 0.001). Conclusion: When determining the cause of altered consciousness in patients with such symptoms, a comprehensive understanding of physiological changes in elderly individuals is crucial. While high blood pressure may indicate neurological diagnoses, tachycardia, tachypnea, and fever may suggest non-neurological causes.