The Etiology of Non-traumatic Loss of Consciousness in Patients Admitted to the Emergency Department

Abstract

Background: Loss of consciousness (LOC) is one of the most common complaints in the emergency department (ED). This disorder can result from a wide range of clinical conditions, such as structural brain damage, infection, shock, respiratory failure, or psychiatric disorders. Objectives: This study was conducted with the aim of investigating the cause and prognosis of patients with non-traumatic LOC referred to two referral hospitals of Mashhad University. Methods: This prospective cohort study was conducted on 1000 patients presenting with complaints of LOC at Ghaem and Imam Reza hospitals in Mashhad in 2020. All patients with a decreased level of consciousness and a Glasgow Coma Scale (GCS) score of less than 14 were included in the investigation. Results: A total of 1037 patients participated in this study, while 37 patients were excluded. Of the participants, 524 (52.4%) were men and 476 (47.6%) were women. The average age was 59.85 ± 16.06 years, ranging from 18 to 95 years. The relatively common causes of LOC included sepsis (38.3%), stroke (9.2%), heart failure (8%), myocardial infarction (7.3%), meningitis (7.2%), hepatic encephalopathy (6.5%), and toxic alcohol ingestion (5.8%). Deceased patients were older, had higher respiratory rates and temperatures, and had lower blood sugar and blood pressure upon admission. A previous history of stroke, hyperlipidemia, hypertension, and diabetes were associated with death. The relationships between different study outcomes were assessed using multivariate binary logistic regression; a two-sided P < 0.05 was considered significant. Conclusions: Patients presenting to the ED with LOC are more likely to die, making LOC a potential prognostic factor for in-hospital death.