OBJECTIVE: Brain computed tomography (CT) is commonly performed to diagnose acute altered mental status (AMS), a critically important symptom in many serious diseases. However, negative CT results are common, which result in unnecessary CT use. Therefore, this study aimed to determine the clinical factors associated with positive CT findings. METHODS: Patients with acute AMS selected from an emergency department-based registry were retrospectively evaluated. Patients with non-traumatic and noncommunicable diseases on initial presentation and with Glasgow Comal Scale scores of < 15 were included in the study. RESULTS: Among the 367 brain CT results of patients with AMS during the study period, 146 (39.8%) were positive. In a multivariate analysis, the presence of focal neurologic deficit (odds ratio [OR], 132.6; 95% confidence interval [CI], 37.8 to 464.6), C-reactive protein level < 2 mg/dL (OR, 3.9; 95% CI, 1.4 to 10.6), and Glasgow Comal Scale score < 9 (OR, 2.4; 95% CI, 1.2 to 4.8) were significantly associated with positive brain CT results. CONCLUSION: The presence of focal neurologic deficit, initial Glasgow Comal Scale score of < 9, and initial C-reactive protein levels of < 2 mg/dL can facilitate the selection of brain CT to diagnose patients with acute AMS in the emergency department.
Brain* ; C-Reactive Protein ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Multivariate Analysis ; Neurologic Manifestations ; Retrospective Studies ; Risk Factors ; Tomography, X-Ray Computed ; Unconsciousness

Objective: Decreases in the hemoglobin level compared to the pre-injury lab results are often observed in patients with elderly hip fractures visiting the emergency department (ED). This decrease could be the outcome of the fracture itself or a complication caused by comorbidities. This study examined whether significant hemoglobin decreases, as detected in the ED, are related to other-than-hip-fracture bleeding focus or clinical outcomes. Methods: The electronic medical records were reviewed retrospectively at a single university ED from January 2012 to March 2019. ED diagnoses of hip fractures were screened and enrolled if the patient was 60 years or older and had hemoglobin levels recorded within the previous 6 months. A significant decrease in the hemoglobin level is defined as more than 2 g/dL. Results: Three hundred patients were enrolled in this study. Significant hemoglobin decreases were apparent in 43 patients (14.3%). Only four patients (1.3%) had an other-than-hip-fracture bleeding focus. One of those had a significant hemoglobin decrease. In a “significant decrease” versus “non-significant decrease” intergroup comparison, length of hospital stays (median and interquartile range: 17.0 [15.0-21.5] vs. 17.0 [12.0-21.0], P=0.55), survival discharge (4.7% vs. 2.3%, P=0.72), and other-than-hip-fracture bleeding focus (2.3% vs. 1.2%, P>0.99) did not differ significantly. Conclusion A decrease in hemoglobin level is common among elderly hip fracture patients. On the other hand, the incidence of other-than-hip-fracture bleeding focus was rare and unrelated to a decrease in significant hemoglobin levels. Similarly, neither the hospital length of stay nor survival discharge was unrelated to the hemoglobin level decrease.

Objective: With the increase in the elderly population worldwide, there has been a corresponding increase in the proportion of elderly patients who visit the emergency department (ED). Therefore, research on the elderly not only aids in the treatment of diseases but also assists in the efficient utilization of limited medical resources. Respiratory symptoms are one of the most common and sometimes life-threatening symptoms in elderly patients. Knowing the factors that can predict the prognosis in advance can help with rapid diagnosis and immediate treatment. Methods: A retrospective study was conducted from September 2019 to March 2020 at an ED in an urban area. Patients with respiratory symptoms who were treated in the critical care area of the ED were reviewed. The ED clinical data were compared with the outcomes in the ED. Results: A total of 750 patients were screened, of which 703 were elderly patients. Many clinical factors showed variations between the elderly and non-elderly patients. Oxygen volume, elevated lactate level, elevated troponin level, hypocalcemia, and hypothermia were related with ED death or ICU admission among the elderly. Conclusion We identified several clinical factors with respect to elderly ED patients with respiratory symptoms that were related to the clinical outcomes and can be used for decision-making and prediction of poor outcomes.