Clinical assessment and short-term mortality prediction of older adults with altered mental status using RASS and 4AT tools

• Published in: The American journal of emergency medicine 2024-01, Vol.75, p.14-21
• Main Authors: Demirtakan, Turker, Cakmak, Fatih, Ipekci, Afsin, Akdeniz, Yonca Senem, Biberoglu, Serap, Ikızceli, Ibrahim, Ozkan, Seda
• Format: Article
• Language: English
• Subjects: 4AT; Aged; Anesthesia; Brain research; Clinical outcomes; Cognitive ability; Coma; Comorbidity; Consciousness; Cooperation; Delirium; Delirium - diagnosis; Dementia; Emergency medical care; Fainting; Guardians; Health risks; Humans; Informed consent; Mental disorders; Mortality; Mortality risk; Nervous System Diseases; Older people; Patients; Prospective Studies; RASS; Respiratory diseases; Statistical analysis; Stupor; Vertigo
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2023.10.022

Altered mental status (AMS) in older adults is a common reason for admission to emergency departments (EDs) and usually results from delirium, stupor, or coma. It is important to proficiently identify underlying factors and anticipate clinical outcomes for those patients. The primary objective of this study was to reveal and compare the clinical outcomes and etiologic factors of older patients with delirium, stupor, and coma. The secondary objective was to identify the 30-day mortality risk for those patients. The study was conducted as prospective and observational research. We included patients aged 65 years and older who presented with new-onset neurological and cognitive symptoms or worsening in baseline mental status. Patients who presented no change in their baseline mental status within 48 h and those who needed urgent interventions were excluded. Selected patients were assessed using RASS and 4AT tools and classified into three groups: stupor/coma, delirium, and no stupor/coma or delirium (no-SCD). Appropriate statistical tests were applied to compare these 3 groups. The 30-day mortality risks were identified by Cox survival analysis and Kaplan-Meier curve. A total of 236 patients were eligible for the study. Based on their RASS and 4AT test scores: 56 (23.7%), 94 (40.6%), and 86 (36.4%) patients formed the stupor/coma, delirium and no-SCD groups, respectively. There was no statistical difference in the three groups for gender, mean age, and medical comorbidities. Neurological (34.7%), infectious (19.4%), and respiratory (19.0%) diseases were the leading factors for AMS. Post-hoc tests showed that CCI scores of the delirium (6, IQR = 3) and stupor/coma (7, IQR = 3) groups were not significantly different. The 30-day mortality rates of stupor/coma, delirium, and no-SCD groups were 42.%, 15.9%, and 12.8%, respectively (p