ETIOLOGIES, DEFINITIVE DIAGNOSIS AND PATIENT OUTCOMES IN ALTERED LEVEL OF CONSCIOUSNESS IN THE EMERGENCY DEPARTMENT

Abstract

Objectives: To determine the common and definitive etiologies of altered level of consciousness in emergency department.To find GCS scores with different  etiological classes and sub classes.To determine Patient outcomes based on GCS scores.

Material and Methods: In this study Prospective observational design was adopted. The study was conducted in Superior University for duration of 4 months. Data was collected from CMH Rawalakot AJK. This study evaluated the GCS sores based on age, etiologies,etiology subclasses .Definitive diagnosis and patient outcomes. inclusion was age 18-90 years and GCS <15. Data was collected through a slightly modified performa.

Results: The study revealed that extra-cranial causes were the most prevalent, accounting for 83 cases, compared to 67 intra-cranial cases. Among the definitive diagnoses, ischemic stroke (14 cases), tonic-clonic seizures (12 cases), and sepsis (12 cases) were the most common, with ischemic stroke being a leading cause among vascular etiologies. Patients were categorized based on their Glasgow Coma Scale (GCS) scores, with the majority in the moderate range (6-8), comprising 44 cases, followed by the severe range (3-5) with 37 cases. The distribution highlighted a higher occurrence of extra-cranial causes in the moderate GCS group. Patient outcomes indicated that ICU admissions were the most frequent, with 35 cases, while 7 deaths were recorded, primarily within the severe GCS range (3- 5).The findings emphasize that extra-cranial causes, particularly ischemic stroke, tonic-clonic seizures, and sepsis, are significant contributors to altered levels of consciousness and highlight the importance of timely and accurate diagnosis and management.

Conclusion: This study underscores the predominance of extra-cranial causes in altered levels of consciousness, with ischemic stroke, tonic-clonic seizures, and sepsis being the most common diagnoses. Lower GCS scores correlated with higher ICU admissions and mortality, highlighting the importance of early detection and management. Timely intervention is crucial to improving outcomes in patients with severe presentations.