Etiologies and delirium rates of elderly ED patients with acutely altered mental status: a multicenter prospective study.

OBJECTIVES: Altered mental status (AMS) is a challenging diagnosis in older patients and has a large range of etiologies. The aim of this study was to investigate the nature of such etiologies for physicians to be better aware of AMS backgrounds and hence improve outcomes and mortality rates. METHODS: This prospective observational study was conducted at 4 emergency departments. Patients 65 years and older who presented to the emergency department with acute AMS (≤1 week), with symptoms ranging from comas and combativeness, were eligible for inclusion in this study. The outcomes, etiologies, Richmond Agitation and Sedation Scale scores, and the presence of delirium were recorded. RESULTS: Among 822 older patients with AMS, infection (39.5%) and neurological diseases (36.5%) were the most common etiologies. The hospital admission and mortality rates were 73.7% (n = 606) and 24.7% (n = 203), respectively. The mortality rate rose if AMS persisted for more than 3 days. Delirium was observed in 55.7% of the patients; these individuals had higher durations of AMS than those without delirium (median, 24 hours; interquartile range, 3-48 hours; median 6 hours, interquartile range, 3-48 hours, respectively; P = .010). Notably, delirium was observed in more than two-thirds of neurological patients. CONCLUSIONS: The most common causes of AMS were infection and neurological diseases. Delirium was associated with AMS in nearly half the patients. Moreover, the rates of hospitalization and mortality remained high.

The association between weather conditions and stroke admissions in Turkey.

Although several factors such as cigarette smoking, blood pressure, diabetes, obesity, hypercholesterolemia, physical inactivity and dietary factors have been well documented to increase the risk for stroke, there are conflicting data about the role of meteorological variables in the etiology of stroke. We conducted a retrospective study to investigate the association between weather patterns, including daily temperature, humidity, wind speed, and air pressure, and stroke admissions to the Emergency Department of Atatürk Training and Research Hospital in Ankara, Turkey, between January 2009 and April 2010. Generalized additive models with logistic link function were used to investigate the relationship between predictors and days with and without stroke admission at lags 0-4. A total of 373 stroke patients were admitted to the emergency department (ED) between January 2009 and April 2010. Of patients, 297 had ischemic stroke (IS), 34 hemorrhagic stroke (HS), and 42 subarachnoidal hemorrhage (SAH). Although we did not find any association between overall admissions due to stroke and meteorological parameters, univariable analysis indicated that there were significantly more SAH cases on days with lower daily mean temperatures of 8.79 ± 8.75 °C as compared to relatively mild days with higher temperatures (mean temperature = 11.89 ± 7.94 °C, p = 0.021). The multivariable analysis demonstrated that admissions due to SAH increased on days with lower daily mean temperatures for the same day (lag 0; odds ratio (OR) [95% confidence interval (95% CI)] = 0.93 [0.89-0.98], p = 0.004) and lag 1 (OR [95% CI] =0.76 [0.67-0.86], p = 0.001). Furthermore, the wind speed at both lag 1 (OR [95% CI] = 1.63 [1.27-2.09], p = 0.001) and lag 3 (OR [95% CI] = 1.43 [1.12-1.81], p = 0.004) increased admissions due to HS, respectively. In conclusion, our study demonstrated that there was an association between ED admissions due to SAH and HS and weather conditions suggesting that meteorological variables may, at least in part, play as risk factors for intracranial hemorrhages.

A Comparison of Pain Scores in Dysmenorrheic Patients With or Without Dyspeptic Symptoms.

Introduction: Dysmenorrhea attacks may be accompanied by extragenital symptoms such as nausea, vomiting, diarrhea, headache and leg pain and by emotional symptoms such as tension and irritability. Therefore, we think that dysmenorrheic symptoms may be more severe in patients with dyspeptic symptoms. The purpose of this study was to determine whether pain scores would differ between dysmenorrheic patients with or without dyspeptic symptoms. METHODS: Patients presenting to the emergency department with dysmenorrhea attacks and volunteering to participate were included in this case-control study. Subjects with dyspeptic symptoms were enrolled as the case group and those without dyspeptic symptoms were enrolled as the control group. Participants were administered the Faces Pain Scale and a questionnaire involving demographic characteristics. RESULTS: Pain scores on arrival were higher in the case group than in the control group (4.20 ± 0.71, 3.70 ± 0.74, n=30, p=0.011). A significant difference was observed between pain scores on arrival and at discharge in both the control and case groups. A decrease in pain scores was determined in all the subjects in the case group, while no change was observed in three volunteers in the control group. CONCLUSIONS: We conclude that pain is significantly more severe in dysmenorrheic patients with dyspeptic symptoms.