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Chinese Journal of Hygiene Rescue(Electronic Edition) ›› 2020, Vol. 06 ›› Issue (06): 350-355. doi: 10.3877/cma.j.issn.2095-9133.2020.06.006

Special Issue:

• Original Article • Previous Articles     Next Articles

Patients with impaired consciousness in the Department of Emergency: a clinical study

Xiaopeng Feng1,(), Zhaoxin Xie1, Yanling Zhang1   

  1. 1. Department of Emergency, First People’s Hospital in Huizhou, Huizhou 516003, China
  • Received:2019-12-02 Online:2020-12-18 Published:2020-12-18
  • Contact: Xiaopeng Feng
  • About author:
    Corresponding author: Feng Xiaopeng, Email:

Abstract:

Objective

To analyze the causes of acute impaired consciousness in patients in an internal emergency department (ED).

Methods

We analyzed all patients who were admitted to the ED of a tertiary hospital with the dominating symptom of "sudden onset unconsciousness" within 2 years (September 2016 until August2017). Patients with a clear diagnosis at arrival that explained the altered state of consciousness or other dominating symptoms at the time of arrival were not included.

Results

A total of 424 patients were analyzed. In 88% of the patients, a final diagnosis could be established in the ED. Most common causes for unconsciousness were cerebrovascular diseases(24.1%), infections (14.2%), epileptic seizures (12%), psychiatric diseases (6.1%), metabolic causes (7.1%), intoxications(9%), transient global amnesia (5.2%) and cardiovascular causes (4.2%). The diagnoses were predominantly established by physical examination in combination with computed tomography(23.1%) and by the results of laboratory testing (25%). In-hospital mortality was 11%, and 59% of all patients were discharged with a Glasgow Outcome Score of 2-4.

Conclusions

This analysis demonstrates a large variety of etiologies in patients with unknown unconsciousness of acute onset who are admitted to an ED. As neurological diagnoses are among the most common etiologies, neurological qualification is required in the ED, and availability of diagnostics such as cerebral imaging is indispensable and recommended as an early step in a standardized clinical approach.

Key words: Impaired consciousness, Emergency room, Coma

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