ABSTRACT OF PAPER PUBLICATION

 Clinico-Etiological profile and outcomes of patients presenting with Acute Altered Sensorium in a Tertiary care center :

ABSTRACT:

INTRODUCTION:

Altered sensorium is a very common emergency case, but the exact etiology of many altered sensorium patients is unknown 1,2. Patients often present with vague symptoms, thus altered sensorium diagnosis and treatment are highly challenging for treating physician.

The aim of this study is to assess the various etiology and clinical presentation of altered sensorium patients.2 This assessment should allow providers to better understand the etiology of altered sensorium and therefore improve diagnostic skills and management.

MATERIALS AND METHODS:

This is a prospective cohort study conducted at Kamineni 

Institute of medical Sciences, Narketpally from May 2021 

to July, 2021. The study involved 70 patients of altered 

Sensorium accounting for 23.3% of all emergency patients. 

RESULTS:

Among 70 patients with altered sensorium patients above 14 years of age, 50 (71.4%) were male, and 20 (28.6%) were female. Etiologic factors were neurological (n=28; 40%) & non neurological (n=37; 52.9 %); multiple etiologies (n=5; 7.1%).Total mortality rate was 11.4% 

(n=8).

Non-neurological causes includes ,uremia (n=12; 32.4%) ;hepatic encephalopathy (n=10; 27%) ;endocrine (n=5; 13.5%);toxins (n=3;8.2%);sepsis (n=2 ;5.4%) ;

hyponatremia (n=5;13.5%).

DISCUSSION:

Patients with altered sensorium present a diagnosing difficulty for physicians. Frequently encountered causes of altered sensorium were primary CNS disorders, CNS infections, seizures, traumatic brain injury, hypoxic brain injury, intoxication, organ system dysfunction, and endocrine/metabolic diseases/hypo and hyperglycemia

and sepsis/hypotension. 3

Altered sensorium is an important warning signal for emergency patients because of its potentially fatal and reversible effects.1 Prompt evaluation and treatment are essential to decrease morbidity and mortality associated with altered sensorium patients.

CONCLUSION:

In our study, we found that non neurological causes for altered sensorium were more common than primary neurological diseases. We also found that few patients have multiple etiologies leading to altered sensorium and it’s difficult to pinpoint the cause in them.

Neuroimaging was helpful in 40% of the cases, highlighting the importance of good history, thorough physical examination & laboratory reports in 60% patients. And hence their importance cannot be overemphasized.

REFERENCES :

1) Hai-yu Xiao, Yu-xuan Wang, et al. Evaluation and

Treatment of altered mental status patients in the

Emergency department: Life in the fast lane. World

Journal of emergency medicine. 2012; 3(4):270-277.

2. Kekec Z, Senol V, Koc F, Seydaoglu G. Analysis of

Altered mental status in Turkey. Int J Neurosci. 2008;

118:609–617.

3) Singhal V. Clinical Approach to Acute Decline in Sensorium. Indian J Crit 

Care Med 2019; 23 (Suppl2):S120–S123.

4) Vikram K, Shivashankara KN, Chakraborty J, Umakanth S. A 

complicated case of altered sensorium. BMJ Case Rep. 2013; 

2013:bcr2013009841. 

5) Chaudhry N, Duggal AK. Sepsis Associated Encephalopathy. Adv Med. 2014; 2014:762320.

Link to my case elogs : 

https://karnativaishnavi.blogspot.com/2021/08/altered-sensorium.html

Results and data : 

FOLLOWING WAS MY PPT MADE FOR TSAPICON ORAL PAPER PRESENTATION AND PRESENTED IN THE CONFERENCE .

CLINICO-ETIOLOGICAL PROFILE AND OUTCOMES OF PATIENTS PRESENTING WITH ACUTE ALTERED SENSORIUM IN A TERTIARY CARE CENTRE.

AUTHOR : DR .K VAISHNAVI.

FINAL YEAR RESIDENT ,

DEPARTMENT OF INTERNAL MEDICINE ,

KAMINENI INSTITUTE OF MEDICAL SCIENCES, NARKETPALLY.

GUIDE – DR RAKESH BISWAS.

HOD AND PROFESSOR ,

DEPARTMENT OF INTERNAL MEDICINE ,

KAMINENI INSTITUTE OF MEDICAL SCIENCES, NARKETPALLY.

OUTLINE :

INTRODUCTION

AIMS AND OBJECTIVES

MATERIALS AND METHODS

INCLUSION AND EXCLUSION CRITERIA

RESULTS

DISCUSSION

OUTCOME

CONCLUSION

REFERENCES 

   INTRODUCTION : 

 Altered sensorium is a group of clinical symptoms rather than specific diagnosis and includes cognitive disorders, attention deficit, arousal disorders and decreased level of consciousness.1

Altered sensorium is a very common presentation in casualty, but the exact etiology of many altered sensorium patients is unknown. 1, 2

 Patients often present with vague symptoms, thus altered sensorium diagnosis and treatment are highly challenging for treating physician.

It is an important warning signal, where timely diagnosis and efficient treatment will improve outcomes significantly.

AIMS AND OBJECTIVES :

 To provide a framework for the assessment of altered sensorium patients.2   

To determine the demographic characteristics, etiology and clinical presentation; outcomes, of patients presenting with altered sensorium.

MATERIALS AND METHODS: 

This is a prospective cohort study conducted at Kamineni Institute of medical Sciences, Narketpally from May 2021 to July, 2021. The study involved 70 patients of altered sensorium accounting for 23.3% of all emergency patients.  

INCLUSION CRITERIA :

GCS < 15 .

Age > 14 years of age .

EXCLUSION CRITERIA:

Age < 14 years.

Chronic altered sensorium patients like Alzheimer’s disease; Schizophrenia and other psychiatric illness.

RESULTS : 

AGE AND SEX DISTRIBUTION OF PATIENTS : 

ETIOLOGICAL DISTRIBUTION : 

                

MULTIPLE ETIOLOGIES : (n=5 )

These patients have more than one etiology on presentation leading to altered sensorium and it’s difficult to pinpoint cause in them .

ASSESMENT OF PATIENTS WITH ALTERED SENSORIUM :

-Detailed History

- Physical examination and CNS examination. 

 -Laboratory tests (included arterial blood gas, CBP, urinalysis, LFT, RFT, Chest X ray, ECG, EEG & ECHO).

 Neuroimaging.

We observed that only 31 patients had positive results after neuroimaging.

      DISCUSSION :

Altered sensorium may result either from a disruption of ascending (ARAS) , a neuronal network running from brainstem to cortex and controlling arousal ,or an impairment in bilateral cortex .

In our study the cause for AMS in the elderly group differed from that in the younger age group, i.e., metabolic diseases, trauma, and alcohol/poisoning were often found in young people, whereas CVA, and sepsis/ organ failure were frequently seen in the elderly.

 In acute AMS, this pattern of age distribution was similar to William and his colleague's research from university of Virginia7.

OUTCOME :

The average duration of hospital stay was 5 days.

During our study, 70 altered sensorium patients were treated and 8 patients died.

The mortality rate was 11.4% , during the hospital stay. The main causes of death were multi system and organ failure (MODS), traumatic brain injury , massive Stroke, multiple acute infarcts ,sepsis , meningo-encephalitis.

LIMITATIONS OF STUDY : 

-Small sample size 

-Single center study

 Our data may not represent the same situation encountered in other hospitals.

                CONCLUSION :

In our study, we found that non neurological causes for altered sensorium were more common than primary neurological diseases.

 We also found that few patients have multiple etiologies on presentation leading to altered sensorium and it’s difficult to pinpoint the cause in them.

Neuroimaging was useful only in 40% of the cases, highlighting the importance of good history, thorough physical and CNS examination & laboratory reports in 60% patients. 

So main impact of my study was to cut down expenses on un-necessary brain imaging and diagnosis are best made in clinical context , an integration of thorough history ,physical examination coupled with labs .8

REFERENCES :

 Hai-yu Xiao, Yu- xuan Wang, et al. Evaluation and Treatment of altered mental status patients in the Emergency department: Life in the fast lane. World Journal of emergency medicine. 2012; 3(4):270-277.

 Kekec Z, Senol V, Koc F, Seydaoglu G. Analysis of Altered mental status in Turkey. Int J Neurosci. 2008; 118:609–617.

 Singhal V. Clinical Approach to Acute Decline in Sensorium. Indian J Crit Care Med 2019; 23 (Suppl2):S120–S123.

 Vikram K, Shivashankara KN, Chakraborty J, Umakanth S. A complicated case of altered sensorium. BMJ Case Rep. 2013; 2013:bcr2013009841. 

 Chaudhry N, Duggal AK. Sepsis Associated Encephalopathy. Adv Med. 2014; 2014:762320.

Leong LB, Wei Jian KH, Vasu A, Seow E. Identifying risk factors for an abnormal computed tomographic scan of the head among patients with altered mental status in the Emergency Department. Eur J Emerg Med 2010; 17: 219–223.

 Kanich W, Brady WJ, Huff JS, Perron AD. Altered mental status: evaluation and etiology in the ED. Am J Emerg Med. 2002 Nov;20(7):613-

 Mistovich JJ, Krost WS, Limmer DD. Beyond the basics interpreting altered mental status assessment findings. EMS Mag 2008; 37: 90–97.