A study of etiological profile of acute confusional state
Keywords:Acute confusional state, Confusion assessment method, Metabolic encephalopathy, Meningoencephalitis, Septic encephalopathy
Background: ACS (Acute confusional states) are on the rise taking the shape of an epidemic. These states are common among the elderly, but young individuals are also not spared. Prompt diagnosis and management of these states can decrease the associated morbidity and mortality.
Methods: In this prospective observational study, etiological profile of ACS was evaluated in a total 100 patients, selected over a period of one year, after they fulfilled the CAM (Confusion Assessment Method) criteria.
Results: Among 100 patients of ACS, mean age was 54.77±18.50 years, males were 66% and 34% were females. The most common diagnosis provisionally made on the basis of history and clinical examination was metabolic encephalopathy in 37% patients, meningoencephalitis (24%), CVA (Cerebrovascular accident) (18%), seizures (9%), sepsis (6%), poisoning (6%). Whereas the final diagnosis made after subjecting the patients to relevant investigations, was metabolic encephalopathy in 37% of patients, meningoencephalitis (20%), CVA (18%), sepsis (12%), unprovoked seizures (6%), poisoning (6%) and undetermined in 1%. The final diagnosis matched the provisional diagnosis in most of the patients except sepsis as a provisional diagnosis was underdiagnosed. The mean duration of hospital stay was 7.6±3.67days and the hospital stay was most commonly complicated by aspiration pneumonia and acute kidney injury.
Conclusions: This study emphasizes that the ACS is an emergency medical situation, where prompt identification, workup and treatment should be done parallelly and urgently to prevent the morbidity and mortality.
Lipowski ZJ. Delirium (acute confusional states). JAMA. 1987;258(13):1789-92.
Ropper AH, Adams R, Victor M, Samuels MA. Adams and Victor's principles of neurology. Delirium and other confusional states.7th ed. New York: McGraw Hill Professional; 2000:1624-36.
McCusker J, Cole M, Dendukuri N, Han L, Belzile E. The course of delirium in older medical inpatients: A prospective study. J Gen Intern Med. 2003;18(9):696-704.
Fong TG, Tulebaev SR, Inouye SK. Delirium in elderly adults: diagnosis, prevention and treatment. Nat Rev Neurol. 2009 Apr;5(4):210-20.
Inouye SK, Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method, a new method for detection of delirium. Annals Int Med. 1990;113(12):941-8.
Sumji S, Wani MI, Mohi-ud-Din M. Prevalence and Etiological Profile of Patients with Acute Confusional State. Int J Sci Stud 2018;6(5):24-9.
Rai D, Garg RK, Malhotra HS, Verma R, Jain A, Tiwari SC, et al. Acute confusional state/delirium: An etiological and prognostic evaluation. Ann Indian Acad Neurol. 2014 Jan;17(1):30-4.
Kanich W, Brady WJ, Huff JS, Perron AD, Holstege C, Lindbeck G, et al. Altered mental status: Evaluation and etiology in the ED. Am J Emerg Med. 2002;20:613-7.
Islam S, Talukdar AJ, Dutta S. A study on etiology of acute confusional state in elderly with short term outcome. IOSR-JDMS. 2016;5(4):1655-9.
Spiller JA, Keen JC. Hypoactive delirium: assessing the extent of the problem for inpatient specialist palliative care. J Palliati Med. 2006 Jan;20(1):17-23.
O'Keeffe, Lavan J. The prognostic significance of delirium in older hospital patients. J Am Geriatr Soc. 1997 Feb;45(2):174-8.
Prinka AS. Comparative study of delirium in emergency and consultation liaison-a tertiary care hospital-based study in northern India. J Clin Diagn Res. 2016 Aug;10(8):01-5.
Nadeem MA, Irfan K, Waheed KAI. Is there any relationship of age and sex to the etiology and outcome of medical coma? Ann King Edw Med Univ. 2005;11(4):407-10.
Grover S, Malhotra S, Bharadwaj R, Bn S, Kumar S. Delirium in children and adolescents. Int J Psychiat Med. 2009 Jun;39(2):179-87.
Xiao HY, Wang YX, Xu TD. Evaluation and treatment of altered mental status patients in emergency department: life in the fast lane. World J Emerg Med. 2012;3(4)270-7.
Iqbal F, Gul A, Hussain S. Predictive value of Glasgow Coma Scale (GCS) in cerebrovascular accidents. Postgrad Med J. 2001;15(2):66-8.