Clinical Analysis on Patients Presenting with Altered Consciousness in the Emergency Room of S. N. U. H

ABSTRACT

OBJECT To analyze clinical'data about the patients presenting with altered consciousness in the emergency room and to plan adequate evaluations and managements. BACKGROLTND. Clinical analysis of comatose patients is necessary. We have a few reports but they don't give enough clues to evaluate the patients rapidly and systematically. METHOD: We included the patients with altered consciousness on the base of the daily reports of emergency room, and reviewed the medical records of the patients. We analyzed the age, sex, visiting date, the patterns of discharge of emergency room, underlying causes, and consequences of the patients. The validity of the contents of daily reports was tested by pilot study. In pilot study, we examined all patients entering emergency room for a week, and compared contents of daily reports with the data acquired from direct examination. RESULTS: The pilot study revealed that the method of patient selection had no problem statistically. The nwnber of patients with altered consciousness entering emergency room, was 594 for one year. The causes of altered consciousness consisted of metabolic problem (35.4%), hemorrhagic stroke (21.2%), malignancy (9.26%), nonhemorrhagic stroke (8. 1%), and others. The causes of metabolic coma werehepatic encephalopathy (69.5%), glucose and electrolyte problem (12.9/o), drug intoxication (6.67%), uremic encephalopathy (6.19%) and alcohol related illness (4.76%). Metabolic coma patients showed better prognosis than others, and hemorrhagic stroke and malignancy showed poor prognosis. The ischemic stroke patients were older than others. Considering the age of the patients, the younger men had better clinical courses than elderly. Significant seasonal variation was notfound. CONCLUSION: The patients visitmg emergency room with altered consciousness had various causes. The most common cause was metabolic origin followed by hemorrhagic stroke. Under the influence of the improvement of socioeconomic status and longevity, the distributions of the underlying disease have changed. The prognosis and consequence of them relied on underlying diseases and age.