Study of Etiological Profile of Patients Presenting with Altered Sensorium to Emergency Department

Abstract

Altered sensorium is a common and potentially life-threatening presentation in the emergency department and may result from a wide range of neurological, metabolic, infective, toxic, and systemic conditions. Early identification of the underlying cause is essential for appropriate management and improving patient outcomes. This observational study was conducted over 18 months in the Emergency Department of Sri Siddhartha Medical College Hospital and Research Centre, Tumakuru, Karnataka, among 150 adult patients presenting with altered sensorium. Patients aged ≥18 years with a Glasgow Coma Scale score <15, disorientation, reduced response to verbal or physical stimuli, or somnolence were included. All patients underwent clinical and neurological assessment, relevant laboratory investigations, and neuroimaging as clinically indicated. Neurological etiologies were the most common cause of altered sensorium (43.3%), followed by metabolic (33.3%), infective (13.3%), toxic (6.7%), and other causes (3.3%). The mean age of the study population was 49.93±16.41 years, with a significant difference across etiological categories. Significant associations were observed between etiology and headache, GCS verbal response, vital parameters, selected biochemical investigations, and neuroimaging findings. ICU admission was required in 91.3% of patients, while 23.3% required ventilatory support. The overall mortality was 21.3%, with neurological etiologies accounting for 62.5% of deaths. Altered sensorium represents a high-risk emergency presentation associated with substantial critical care requirements and mortality. The predominance of neurological and metabolic causes highlights the importance of prompt and systematic neurological, metabolic, and systemic evaluation for early identification of the underlying etiology and appropriate management.