Title: Altered Mental Status: Diagnostic value of various clinical parameters and diagnostic accuracy in emergency department
Authors: Hilal A Sheikh, Wani A. Mushtaq
DOI: https://dx.doi.org/10.18535/jmscr/v7i2.106
Abstract
Background: Evaluation of a patient with Altered Mental Status AMS in the Emergency department ED is difficult for many reasons. Emergency physician is usually expected to make q a correct working provisional diagnosis in AMS in quick time; and the accuracy of this provisional diagnosis has an important bearing sometimes on prognosis of patient
Objective: The Aim of the study was to determine retrospectively the diagnostic accuracy in the Emergency Department and to determine diagnostic value of various components of clinical evaluation.
Methods: The study was conducted prospectively in 201 patients who presented to a tertiary care hospital with AMS .Children, and patients with history of dementia, psychiatric disease, were excluded. History and examination was done, and provisional diagnosis made. CT scan head & CSF analysis were routinely done. All required investigations were done to reach the final diagnosis.
Results: In 11.4% provisional diagnosis did not match with final diagnosis, in 16.4%, diagnosis matched partially, in 71.6 % diagnosis matched completely. The specific features of the clinical evaluation of diagnostic value followed by rates of positive diagnostic finding included: History 76.6%, Examination 65.7%, CBC 4%, and Blood sugar 11.4%. KFT6%, ABG 9.5%, Electrolytes5%, LFT3.5%, CSF6%,CT Scan 37.3%, CXR 8.5%, ECG3.5%,others 8.5%.
Conclusion: There was very good match between initial provisional diagnosis and final diagnosis at discharge. The features of clinical evaluation having highest positive diagnostic value were history, examination, CT head and blood sugar.
Keywords: Altered Mental Status; Diagnostic accuracy; evaluation of AMS ;clinical parameters; Diagnostic value.
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