Can the Bispectral Index Monitor Quantify Altered Level of Consciousness in Emergency Department Patients?

Background: Altered level of consciousness (ALC) is a challenging condition in the emergency department (ED). We evaluated the clinical characteristics, causes, and prognosis of adult patients presenting with ALC at an ED of a university hospital.Methods: The medical records of patients with ALC who visited the ED of a university hospital from February 2019 to November 2020 were reviewed to compare before and after the outbreak of coronavirus disease-19 (COVID-19) in Daegu, South Korea. The cause of ALC, its classification, the patients’ destinations, and prognosis were carefully decided and compared.Results: A total of 1,851 patients with ALC in ED consisted of 1,068 before COVID-19 (BC; to February 17th, 2020) and 783 after COVID-19 (AC; from February 18th, 2020) were investigated. The all-time leading cause of ALC in ED was systemic infection (29.2% in BC, 25.0% in AC), followed by metabolic cause (21.0%) in BC and stroke (18.4%) in AC. Extra-cerebral etiologies of ALC were 1,206 (65.1%). The overall mortality of ALC in ED was 12.3%, consisting of 11.0% in BC and 14.2% in AC. During the daytime (07:00 to 18:59), patients in overall 1,179 patients (63.7%) with ALC visited ED, consisted of 665 (62.3%) in BC and 514 (65.5%) in AC.Conclusions: This study demonstrated the extra-cerebral etiologies as the major causes of ALC in the ED. And there have been shifts in the etiology of ALC in ED.

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Does the Level of Prehospital Care Influence the Outcome of Patients with Altered Levels of Consciousness?

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00042722 ◽

1996 ◽

Vol 11 (2) ◽

pp. 101-104 ◽

Cited By ~ 11

Author(s):

James Adams ◽

Gene Aldag ◽

Robert Wolford

Keyword(s):

Emergency Department ◽

Life Support ◽

Prehospital Care ◽

Advanced Life Support ◽

Admission Rate ◽

Mean Value ◽

Altered Level ◽

Levels Of Care ◽

Level Of Consciousness ◽

Als Patients

AbstractHypothesis:Significant differences exist in the outcome of patients with altered level of consciousness (ALOC) cared for by advanced life support (ALS) compared with basic life support (BLS) prehospital providers.Methods:Patients transported by ambulance to a community teaching hospital during an 11-month period were studied retrospectively. Study patients were those considered not alert by prehospital personnel. Exclusion criteria included: trauma, intoxication, drowning, shock, and cardiac arrest. Data were abstracted from the ambulance reports and hospital records.Results:Two hundred three patients with an ALOC were identified; 113 were transported by ALS providers (56%) and 90 (44%) by BLS providers. Prehospital levels of consciousness, according to the “alert, verbal, painful, unresponsive” scale (ALS vs BLS) were: “verbal” (40% vs 51%), “painful” (23% vs 23%), and “unresponsive” (37% vs 25%). The mean value for scene time was 15±6 minutes for ALS versus 10±4 minutes for BLS (p <0.001). On arrival in the emergency department, the LOC of 72 (64 %) ALS patients and 58 (64%) BLS patients had improved to “alert.” The level of consciousness in one ALS patient worsened. Fifty-two ALS (46%) and 38 (42%) BLS patients were admitted. Principal final diagnoses were seizure (27% ALS vs 38% BLS), hypoglycemia (23% ALS vs 23% BLS), and stroke (22% ALS vs 20% BLS). Remaining diagnoses each constituted less than 7% of total discharge diagnoses. No statistically significant differences in measures of outcome were noted between ALS or BLS patients. Diagnoses of seizure, stroke, and hypoglycemia were studied individually. No differences in admission rate, mortality rate, or disposition were identified. Hypoglycemic patients conveyed by ALS provider had significantly shorter emergency department treatment times than did those transported by BLS providers (160±62 minutes ALS vs 229±67 minutes BLS [p <0.005]).Conclusion:Advanced life support levels of care of patients with an ALOC does not significantly change outcome compared with those receiving BLS care with the exception of shorter emergency department treatment times for hypoglycemic patients.

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Correlation between bispectral index value and modified Glasgow Coma Scale score in dogs with altered level of consciousness

Journal of Veterinary Emergency and Critical Care ◽

10.1111/vec.13014 ◽

2020 ◽

Author(s):

Phitchaya Saenubol ◽

Areerath Akatvipat ◽

Apisate Pleumsamran ◽

Siwaporn Chankrachang

Keyword(s):

Glasgow Coma Scale ◽

Scale Score ◽

Bispectral Index ◽

Glasgow Coma Scale Score ◽

Altered Level ◽

Coma Scale ◽

Level Of Consciousness ◽

Index Value

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The etiologies of altered level of consciousness in the emergency department

Journal of Neurocritical Care ◽

10.18700/jnc.200010 ◽

2020 ◽

Vol 13 (2) ◽

pp. 86-91

Author(s):

Suwon Jung ◽

Jae Cheon Jeon ◽

Chang-Gyu Jung ◽

Yong Won Cho ◽

Keun Tae Kim

Keyword(s):

Emergency Department ◽

Altered Level ◽

Level Of Consciousness

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Oculogyric crisis masquerading as ventriculoperitoneal shunt dysfunction

Journal of Neurosurgery ◽

10.3171/jns/2008/109/11/0944 ◽

2008 ◽

Vol 109 (5) ◽

pp. 944-945 ◽

Cited By ~ 1

Author(s):

Nail H. AlAzwary ◽

Taim Muayqil ◽

Zaeem A. Siddiqi ◽

S. Nizam Ahmed

Keyword(s):

Emergency Department ◽

Ventriculoperitoneal Shunt ◽

Differential Diagnoses ◽

Altered Level ◽

Vp Shunt ◽

The Past ◽

Oculogyric Crisis ◽

Level Of Consciousness ◽

Neurology Clinic ◽

Shunt Dysfunction

Oculogyric crisis (OGC) is an underrecognized oculodystonic reaction associated with several medications including carbamazepine. The authors present a patient who had presented to the emergency department on multiple occasions with a questionable ventriculoperitoneal (VP) shunt dysfunction. Symptoms included nausea, vomiting, altered level of consciousness, ataxia, and vertical eye deviation. The patient underwent multiple revisions of the VP shunt with transient and questionable improvement. During her visit to the neurology clinic, OGC from carbamazepine was suspected, and the dose was reduced. The patient has been completely asymptomatic for the past 18 months. The authors report this case to increase the awareness of carbamazepine-induced OGC as one of the differential diagnoses for VP shunt dysfunction.

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