DOI QR코드

DOI QR Code

Characteristics of patients with decreased mental status while staying in an emergency department: Comparative study with alert patients

응급실 체류 중에 의식이 저하된 환자의 특성: 의식명료 환자와의 비교연구

  • Received : 2018.06.26
  • Accepted : 2018.10.05
  • Published : 2018.10.31

Abstract

This was a retrospective study that compared the characteristics of patients with decreased mental status (DMS) during their stays in an emergency department (ED) with that of patients with alert mental status (AMS). The participants in this study consisted of 90 patients with DMS who were staying in an ED along with 100 randomly selected patients with AMS. The DMS group contained more instances of cerebrovascular disease, liver disease, diabetes, and hypertension compared to the AMS group (p=0.001, p=0.003, p<0.001, and p=0.002, respectively). With regard to triage, the DMS group had higher severity than the AMS group (p<.001). The final diagnosis for the DMS group was as follows: 64.9% neurological and 63.3% related to the digestive system, which differed from that of the AMS group (p<.001). Fifty-six (62.2%) patients with DMS had their statuses discovered by nurses, while nine patients in the DMS group had received cardiopulmonary resuscitation. These results suggest that ED nurses frequently assess the consciousness of patients who they suspect may have neurologic or digestive diseases and are classified as high severity, even when the patients are alert.

Keywords

Emergency nursing;Mental Disorders;Treatment Outcome;Triage;Cardiopulmonary Resuscitation

Acknowledgement

Supported by : 광주대학교

References

  1. H. C. Jin, J. Y. No, S. J. Jo, S. L. Lee, S. J. Kim, S. Y. Lyu, H. Y. Kim, "The Clinical Analysis on the Altered Mental Status in the ED", Journal of The Korean Society of Emergency Medicine, Vol.14, No5, pp.615-623, 2003.
  2. W. Kanich, W. J. Brady, J. S. Huff, A. D. Perron, C. Holstege, G. Lindbeck, C. T. Carter, "Altered mental status: Evaluation and etiology in the ED", The American Journal of Emergency Medicine, Vol.20, No7, pp.613-617, 2002. DOI: https://dx.doi.org/10.1053/ajem.2002.35464 https://doi.org/10.1053/ajem.2002.35464
  3. National Emergency Medical Center, 2016 Annual report of Korean emergency medicine [Internet]. Seoul: Korean Statistical Information Service, [cited 2017 Oct 10], Avaliable from: http://www.e-gen.or.kr/nemc/statistics_annual_report.do. (accessed April, 10, 2018)
  4. Emergency Nurses Association. Emergency nursing core curriculum, pp.23-30, Elsevier Health Sciences, 2017.
  5. S. H. Moon, Y. H. Park, "Concept Analysis of Triage Competency in Emergency Nursing", Journal of Korean Critical Care Nursing, Vol.10, No3, pp.41-52, 2017.
  6. B. J. Kim, U. N. Lee, K. H. Kang, S. S. Kim, S. A. Kim, Y. H. Sung, D. S. Shin, K. O. Yi, H. J. Lee, "A Study of Job Analysis of the Emergency Room Nurse", Journal of Korean Clinical Nursing Research, Vol.12, No1, pp.81-95, 2006.
  7. TA Edwards, Art of triage, pp.7-49, Nova Science Publishers, 2014.
  8. H. J. Song, Emergency Medical Service System and Policy Implications in Korea, Health and welfare policy forum, Vol.90, pp.63-73, 2004.
  9. S. M. Mun, S G. Jeong, Y. M. Oh, S. M. Choe, G. H. Cheo. K. N. Park, J. S. Oh, "Effect of Issuing of Hospitalization Sheets by Emergency Department on Shortening Length of Stay", The Korean Society of Emergency Medicine, Vol.20, No.1, pp.10-19, 2009.
  10. Z. Kekec, V. Senol, F. Koc, G. Seydaoglu, "Analysis of Altered Mental Status in Turkey", International Journal of Neuroscience, Vol.118, No.5, pp.609-617, 2008. DOI: https://dx.doi.org/10.1080/00207450701849133 https://doi.org/10.1080/00207450701849133
  11. J. P. Choi, Altered Mental Status in Emergency Department Patients : Etiologies and Outcomes, Konyang University, Master Thesis, 2007.
  12. S. I. Yoo, H. S. Won, J. H. Jung, S. H. Jang, "Clinical Analysis on Patients with Altered Mental Status in the Emergency Department: Elderly versus Adult Patients", Annals of geriatric medicine and research, Vol.12, No2, pp.82-88, 2008.
  13. S. Y. Youk, "Nursing Competency and Indicator Development by Emergency Nurse's Clinical Ladder", Journal of Korean Academy of Nursing Administration, Vol.9, No3, pp.481-494, 2003.
  14. World Health Organization, ICD-10 Version: 2010 [Internet]. World Health Organization, Avaliable from: http://apps.who.int/classifications/icd10/browse/2010/en. (accessed April, 15, 2018)
  15. J. E. Tintinalli, J. S. Stapczynski, O. J. Ma, D. M. Cline, G. D. Meckler, "Altered Mental Status and Coma. Tintinalli's Emergency Medicine: A Comprehensive Study Guide", 8e edition, McGraw Hill Professional, 2016.
  16. J. H. Lee, J. S. Seo, D. H. Seol, M. S. P. Choe, K. S. Seo, J. B. Park, J. M. Chung, "Clinical Review of Elderly Patients Who Visited the Emergency Department with Altered Mental Status", The Korean Society of Emergency Medicine, Vol.15, No.1, pp.24-29, 2004.
  17. S.Y. Park, J. M. Woo, "Delirium of Elderly Patients in Emergency Room", The Korean Society of Biological Therapies in Psychiatry, Vol.18, No.2, pp.104-110, 2012.
  18. K. H. Kang, "Predictors of Emergency Medical Transports Use Based on 2009", Korea Health Panel, Vol.28, No.3, pp.80-86, 2014.
  19. C. O'Keeffe, S. Mason, R. Jacques, J. Nicholl, "Characterising non-urgent users of the emergency department (ED): A retrospective analysis of routine ED data", PLOS ONE, Vol.13, No.2, Article ID e0192855, 2018. DOI: https://dx.doi.org/10.1371/journal.pone.0192855
  20. H. Xiao, Y. Wang, T. Xu, H. Zhu, S. Guo, Z. Wang, X. Yu, "Evaluation and treatment of altered mental status patients in the emergency department: life in the fast lane", World Journal of Emergency Medicine, Vol.3, No.4, pp.270-77, 2012. DOI: https://dx.doi.org/10.5847/wjem.j.issn.1920-8642. 2012.04.006 https://doi.org/10.5847/wjem.j.issn.1920-8642.2012.04.006
  21. M. A. Aslaner, M. Boz, A. Celik, A. Ahmedali, S. Eroglu, N. M. Aksu, S. E. Eroglu, "Etiologies and delirium rates of elderly ED patients with acutely altered mental status: a multicenter prospective study", The American Journal of Emergency Medicine, Vol.35, No.1, pp.71-76, 2017. DOI: https://dx.doi.org/10.1016/j.ajem.2016.10.004 https://doi.org/10.1016/j.ajem.2016.10.004