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Omar WM, Khader IRA, Hani SB, ALBashtawy M. The Glasgow Coma Scale and Full Outline of Unresponsiveness score evaluation to predict patient outcomes with neurological illnesses in intensive care units in West Bank: a prospective cross-sectional study. Acute Crit Care 2024; 39:408-419. [PMID: 39266276 PMCID: PMC11392694 DOI: 10.4266/acc.2024.00570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 07/21/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Determining the clinical neurological state of the patient is essential for making decisions and forecasting results. The Glasgow Coma Scale and the Full Outline of Unresponsiveness (FOUR) Scale are commonly used tools for measuring behavioral consciousness. This study aims to compare scales among patients with neurological disorders in intensive care units (ICUs) in the West Bank. METHODS A prospective cross-sectional design was employed. All patients admitted to ICUs who met inclusion criteria were involved in this study. Data were collected from from An-Najah National University, Al-Watani, and Rafedia Hospital. Both tools were used to collect data. RESULTS A total of 84 patients were assessed, 69.0% of the patients were male, and the average length of stay was 6.4 days. The mean score on the Glasgow Coma scale was 11.2 on admission 11.6 after 48 hours, and 12.2 on discharge. The mean FOUR Scale score was 12.2 on admission, 12.4 after 48 hours, and 12.5 at discharge. CONCLUSIONS This study indicates that both the Glasgow Coma Scale and the FOUR scale are effective in predicting outcomes for neurologically deteriorated critically ill patients. However, the FOUR scale proved to be more reliable when assessing outcomes in ICU patients.
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Affiliation(s)
| | | | - Salam Bani Hani
- Department of Nursing, Irbid National University, Irbid, Jordan
| | - Mohammed ALBashtawy
- Department of Community and Mental Health, Princess Salma Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
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Acar D, Tekin FC. The problem of unconscious and unidentified patients in emergency department admissions; a 3-year retrospective study. PLoS One 2024; 19:e0307540. [PMID: 39046967 PMCID: PMC11268634 DOI: 10.1371/journal.pone.0307540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
Unidentified patients present a medical information dilemma for all medical departments but can be a major problem in Emergency Departments (EDs). This study aimed to determine the clinical and socio-demographic profile of 'unidentified' patients admitted to the ED with altered consciousness and to define the outcomes of these patients. All ED presentations were analyzed retrospectively for the unidentified patients brought to the hospital by ambulance with altered consciousness. We assessed demographic data, clinical presentation, discharge information, and major clinical outcomes. In this study, 1324 unidentified patients were admitted with altered consciousness to the ED. Of these, 1048 (80.1%) were foreign nationals. In this patient group, the most common diagnoses were; traffic accidents, assault or sharp object injuries, drug addicts, or syncope-epilepsy. In addition, the number of patients who left the hospital without permission or escaped and therefore could not be diagnosed was higher in the foreign nationalities group and constituted approximately one-fifth of the patients (18.9% vs. 5.4%, p:0.001). Of the unidentified patients, 903 (68.2%) were discharged after treatment. 351 (26.5%) patients left the ED unattended. 32 (2.4%) patients were hospitalized. 38 (2.9%) patients died in ED. The majority of the unidentified patients admitted to the ED with altered consciousness were immigrant males. Unidentified patients are a high-need population, most commonly presenting with substance misuse or trauma. Although most of the patients were seeking urgent treatment, more than one-fourth of the patients left the hospital without appropriate treatment and most of these patients were also immigrants. We believe that economic, linguistic, and social disadvantages played an important role in this outcome.
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Affiliation(s)
- Demet Acar
- Department of Emergency Medicine, Konya City Hospital, Karatay, Konya, Türkiye
| | - Fatih Cemal Tekin
- Department of Emergency Medicine, Konya City Hospital, Karatay, Konya, Türkiye
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Dekundy A, Pichler G, El Badry R, Scheschonka A, Danysz W. Amantadine for Traumatic Brain Injury-Supporting Evidence and Mode of Action. Biomedicines 2024; 12:1558. [PMID: 39062131 PMCID: PMC11274811 DOI: 10.3390/biomedicines12071558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Traumatic brain injury (TBI) is an important global clinical issue, requiring not only prevention but also effective treatment. Following TBI, diverse parallel and intertwined pathological mechanisms affecting biochemical, neurochemical, and inflammatory pathways can have a severe impact on the patient's quality of life. The current review summarizes the evidence for the utility of amantadine in TBI in connection to its mechanism of action. Amantadine, the drug combining multiple mechanisms of action, may offer both neuroprotective and neuroactivating effects in TBI patients. Indeed, the use of amantadine in TBI has been encouraged by several clinical practice guidelines/recommendations. Amantadine is also available as an infusion, which may be of particular benefit in unconscious patients with TBI due to immediate delivery to the central nervous system and the possibility of precise dosing. In other situations, orally administered amantadine may be used. There are several questions that remain to be addressed: can amantadine be effective in disorders of consciousness requiring long-term treatment and in combination with drugs approved for the treatment of TBI? Do the observed beneficial effects of amantadine extend to disorders of consciousness due to factors other than TBI? Well-controlled clinical studies are warranted to ultimately confirm its utility in the TBI and provide answers to these questions.
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Affiliation(s)
- Andrzej Dekundy
- Merz Therapeutics GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt am Main, Germany; (A.D.); (A.S.)
| | - Gerald Pichler
- Department of Neurology, Albert-Schweitzer-Hospital Graz, Albert-Schweitzer-Gasse 36, 8020 Graz, Austria;
| | - Reda El Badry
- Department of Neurology and Psychiatry, Faculty of Medicine, Assiut University Hospital, Assiut University, Assiut 71526, Egypt;
| | - Astrid Scheschonka
- Merz Therapeutics GmbH, Eckenheimer Landstraße 100, 60318 Frankfurt am Main, Germany; (A.D.); (A.S.)
| | - Wojciech Danysz
- Danysz Pharmacology Consulting, Vor den Gärten 16, 61130 Nidderau, Germany
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Soeno S, Liu K, Watanabe S, Sonoo T, Goto T. Development of novel optical character recognition system to reduce recording time for vital signs and prescriptions: A simulation-based study. PLoS One 2024; 19:e0296319. [PMID: 38241403 PMCID: PMC10798482 DOI: 10.1371/journal.pone.0296319] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/11/2023] [Indexed: 01/21/2024] Open
Abstract
Digital advancements can reduce the burden of recording clinical information. This intra-subject experimental study compared the time and error rates for recording vital signs and prescriptions between an optical character reader (OCR) and manual typing. This study was conducted at three community hospitals and two fire departments in Japan. Thirty-eight volunteers (15 paramedics, 10 nurses, and 13 physicians) participated in the study. We prepared six sample pictures: three ambulance monitors for vital signs (normal, abnormal, and shock) and three pharmacy notebooks that provided prescriptions (two, four, or six medications). The participants recorded the data for each picture using an OCR or by manually typing on a smartphone. The outcomes were recording time and error rate defined as the number of characters with omissions or misrecognitions/misspellings of the total number of characters. Data were analyzed using paired Wilcoxon signed-rank sum and McNemar's tests. The recording times for vital signs were similar between groups (normal state, 21 s [interquartile range (IQR), 17-26 s] for OCR vs. 23 s [IQR, 18-31 s] for manual typing). In contrast, prescription recording was faster with the OCR (e.g., six-medication list, 18 s [IQR, 14-21 s] for OCR vs. 144 s [IQR, 112-187 s] for manual typing). The OCR had fewer errors than manual typing for both vital signs and prescriptions (0/1056 [0%] vs. 14/1056 [1.32%]; p<0.001 and 30/4814 [0.62%] vs. 53/4814 [1.10%], respectively). In conclusion, the developed OCR reduced the recording time for prescriptions but not vital signs. The OCR showed lower error rates than manual typing for both vital signs and prescription data.
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Affiliation(s)
- Shoko Soeno
- Palliative Care Department, Southern Tohoku General Hospital, Kohriyama, Fukushima, Japan
| | - Keibun Liu
- TXP Medical Co. Ltd., Bunkyo-ku, Tokyo, Japan
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Yeoh CW, Law WC. A case report of near-missed heat stroke. Medicine (Baltimore) 2023; 102:e36676. [PMID: 38134114 PMCID: PMC10735119 DOI: 10.1097/md.0000000000036676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
RATIONALE Heat-related illnesses have protean manifestations that can mimic other life-threatening conditions. The diagnosis of heat stroke requires a high index of suspicion if the patient has been exposed to a high-temperature environment. Central nervous system dysfunction is a cardinal feature. Strict adherence to temperature criteria can potentially lead to misdiagnosis. PATIENT CONCERNS A 37-year-old construction worker was brought in by his wife and coworker due to a sudden loss of consciousness while resting after completing his work. DIAGNOSES Due to challenges faced during the coronavirus disease 2019 pandemic, as well as language barriers, a detailed history from the coworker who witnessed the patient's altered sensorium was not available. He was initially suspected of having encephalitis and brainstem stroke. However, subsequent investigations revealed multiorgan dysfunction with a normal brain computed tomography and cerebral computed tomography angiogram. In view of the multiple risk factors for heat stroke, pupillary constriction, and urine color suggestive of rhabdomyolysis, a diagnosis of heat stroke was made. INTERVENTIONS Despite delayed diagnosis, the patient's multiorgan dysfunction recovered within days with basic supportive care. OUTCOMES There were no noticeable complications on follow-up 14 months later. LESSONS Heat stroke can be easily confused with other neurological pathologies, particularly if no history can be obtained from the patient or informant. When approaching a comatose patient, we propose that serum creatinine kinase should be considered as an initial biochemical screening test.
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Affiliation(s)
- Cheng Wooi Yeoh
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Malaysia Sarawak, Jalan Datuk Mohammad Musa, Kota Samarahan, Sarawak, Malaysia
- Department of Medicine, Sarawak General Hospital, Jalan Hospital, Kuching, Sarawak, Malaysia
| | - Wan Chung Law
- Department of Medicine, Sarawak General Hospital, Jalan Hospital, Kuching, Sarawak, Malaysia
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Mateso GQ, Makali S, Shamamba A, Ntaboba B, Urbain V, Eric M, Murhabazi E, Mihigo M, Mwene-Batu P, Kabego L, Baguma M. Etiologies and factors associated with mortality in patients with non-traumatic coma in a tertiary hospital in Bukavu, eastern Democratic Republic of the Congo. Heliyon 2023; 9:e18398. [PMID: 37520991 PMCID: PMC10382283 DOI: 10.1016/j.heliyon.2023.e18398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023] Open
Abstract
Non-traumatic coma (NTC) is a common medical condition often associated with poor outcomes. Identifying underlying causes is crucial for effective management and prognostication, particularly in resource-poor settings. This study aimed to identify the most common causes and prognostic factors of NTC in a tertiary hospital in Bukavu, in the eastern Democratic Republic of the Congo (DRC), using the Glasgow Coma Scale (GCS) as well as other simple and affordable clinical and paraclinical tools. This retrospective observational study included 219 consecutive patients admitted to the intensive care unit of the Provincial General Hospital of Bukavu between January 2016 and December 2018. Sociodemographic, clinical, and laboratory data were also collected. Bivariate and multivariate analyses were performed to identify different causes and factors associated with poor outcomes in these patients. The median age of the patients was 49 (interquartile range [IQR]: 33-61) years, and they were predominantly men (62.8%). The most common causes of NTC were stroke (25.7%), acute metabolic complications of diabetes (21.9%), and primary brain infections (meningoencephalitis, 16.0%; and cerebral malaria, 14.2%). The NTC-related in-hospital mortality rate was 35.2%. A high mortality was significantly and independently associated with a GCS<7 (adjusted odds ratio [OR]: 4.30, 95% confidence interval [CI]: 1.73-10.71), the presence of meningismus at clinical evaluation (adjusted odds ratio [aOR] 3.86, 95%CI: 1.41-10.55), oxygen saturation <90% (aOR 3.99, 95%CI: 1.71-9.28), the consumption of traditional herbal medicines prior to hospital admission (aOR 2.82, 95%CI: 1.16-6.86), and elevated serum creatinine (aOR 1.64, 95%CI: 1.17-2.29). In conclusion, clinical neurological examinations, along with simple and affordable paraclinical investigations, can provide sufficient information to determine the etiology of NTC and evaluate the prognosis of comatose patients, even in resource-poor settings. Physicians may use the GCS as a simple, reliable, and affordable tool to identify patients who require special attention and care.
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Affiliation(s)
- Guy-Quesney Mateso
- Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo
| | - Samuel Makali
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo
- École Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, The Democratic Republic of the Congo
| | - Ashuza Shamamba
- Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
| | - Balola Ntaboba
- Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
| | - Victoire Urbain
- Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
| | - Musingilwa Eric
- Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
| | - Emmanuel Murhabazi
- Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
| | - Martine Mihigo
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo
| | - Pacifique Mwene-Batu
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo
- École Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, The Democratic Republic of the Congo
| | - Landry Kabego
- Department of Medical Biology, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Marius Baguma
- Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, The Democratic Republic of the Congo
- Center for Tropical Diseases and Global Health (CTDGH), Université Catholique de Bukavu (UCB), Bukavu, The Democratic Republic of the Congo
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Mandeng Ma Linwa E, Binam Bikoi C, Tochie Noutakdie J, Ndoye Ndo E, Bikoy JM, Eposse Ekoube C, Fogue Mogoung R, Simo Ghomsi I, Budzi MN, Ngo Linwa EE, Meh MG, Mekolo D. In-ICU Outcomes of Critically Ill Patients in a Reference Cameroonian Intensive Care Unit: A Retrospective Cohort Study. Crit Care Res Pract 2023; 2023:6074700. [PMID: 37197155 PMCID: PMC10185429 DOI: 10.1155/2023/6074700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/17/2023] [Accepted: 04/25/2023] [Indexed: 05/19/2023] Open
Abstract
Introduction Mortality rate amongst critically ill patients admitted to the intensive care unit (ICU) is disproportionately high in sub-Saharan African countries such as Cameroon. Identifying factors associated with higher in-ICU mortality guides more aggressive resuscitative measures to curb mortality, but the dearth of data on predictors of in-ICU mortality precludes this action. We aimed to determine predictors of in-ICU mortality in a major referral ICU in Cameroon. Methodology. This was a retrospective cohort study of all patients admitted to the ICU of Douala Laquintinie Hospital from 1st of March 2021 to 28th February 2022. We performed a multivariable analysis of sociodemographic, vital signs on admission, and other clinical and laboratory variables of patients discharged alive and dead from the ICU to control for confounding factors. Significance level was set at p < 0.05. Results Overall, the in-ICU mortality rate was 59.4% out of 662 ICU admissions. Factors independently associated with in-ICU mortality were deep coma (aOR = 0.48 (0.23-0.96), 95% CI, p = 0.043), and hypernatremia (>145 meq/L) (aOR = 0.39 (0.17-0.84) 95% CI, p = 0.022). Conclusion The in-ICU mortality rate in this major referral Cameroonian ICU is high. Six in 10 patients admitted to the ICU die. Patients were more likely to die if admitted with deep coma and high sodium levels in the blood.
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Affiliation(s)
- Edgar Mandeng Ma Linwa
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Intensive Care Unit, Laquintinie Hospital Douala, Douala, Cameroon
| | | | | | | | - Jean Moise Bikoy
- Anaesthesiology Unit, Laquintinie Hospital Douala, Douala, Cameroon
| | | | - Raissa Fogue Mogoung
- Intensive Care Unit, Laquintinie Hospital Douala, Douala, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | - Igor Simo Ghomsi
- Intensive Care Unit, Laquintinie Hospital Douala, Douala, Cameroon
- Faculty of Health Sciences, University of Bamenda, Bamenda, Cameroon
| | | | | | - Martin Geh Meh
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - David Mekolo
- Intensive Care Unit, Laquintinie Hospital Douala, Douala, Cameroon
- Emergency Unit, Laquintinie Hospital Douala, Douala, Cameroon
- Anaesthesiology Unit, Laquintinie Hospital Douala, Douala, Cameroon
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Accuracy of prehospital triage systems for mass casualty incidents in trauma register studies - A systematic review and meta-analysis of diagnostic test accuracy studies. Injury 2022; 53:2725-2733. [PMID: 35660101 DOI: 10.1016/j.injury.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prioritising patients in mass casualty incidents (MCI) can be extremely difficult. Therefore, triage systems are important in every emergency medical service. This study reviews the accuracy of primary triage systems for MCI in trauma register studies. METHODS We registered a protocol at PROSPERO ID: CRD42018115438. We searched MEDLINE, EMBASE, Central, Web of Science, Scopus, Clinical Trials, Google Scholar, and reference lists for eligible studies. We included studies that both examined a primary triage system for MCI in trauma registers and provided sensitivity and specificity for critically injured vs non-critically injured as results. We excluded studies that used paediatric, chemical, biological, radiological or nuclear MCIs populations or triage systems. Finally, we calculated intra-study relative sensitivity, specificity and diagnostic odds ratio for each triage system. RESULTS Triage Sieve (TS) significantly underperformed in relative diagnostic odds ratio (DOR) when compared to START and CareFlight (CF) (START vs TS: 19.85 vs 13.23 (p<0.0001)│CF vs TS: 23.72 vs 12.83 (p<0.0001)). There was no significant difference in DOR between TS and Military Sieve (MS) (p<0.710). Compared to START, MS and CF TS had significantly higher relative specificity (START vs TS: 93.6% vs 96.1% (p=0.047)│CF vs TS: 96% vs 95.3% (p=0.0006)│MS vs TS: 94% vs 88.3% (p=0.0002)) and lower relative sensitivity (START vs TS: 57.8% vs 34.8% (p<0.0001)│CF vs TS: 53.9% vs 34.7% (p<0.0001)│MS vs TS: 51.9% vs 35.2% p<0.0001)). CF had significantly better relative DOR than START (CF vs START: 23.56 vs 27.79 (p=0.043)). MS had significantly better relative sensitivity than CF and START (MS vs CF: 49.5% vs 38.7% (p<0.0001)│MS vs START: 49.4% vs 43.9% (p=0.01)). In contrast, CF had significantly better relative specificity than MS (MS vs CF: 91.3% vs 93.3% (p<0.0001)). The remaining comparisons did not yield any significant differences. CONCLUSION As the included studies were at risk of bias and had heterogenic characteristics, our results should be interpreted with caution. Nonetheless, our results point towards inferior accuracy of Triage Sieve compared to START and CareFlight, and less firmly point towards superior accuracy of Military Sieve compared to START, CareFlight and Triage Sieve.
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Adan Ali H, Farah Yusuf Mohamud M. Epidemiology, Risk Factors and Etiology of Altered Level of Consciousness Among Patients Attending the Emergency Department at a Tertiary Hospital in Mogadishu, Somalia. Int J Gen Med 2022; 15:5297-5306. [PMID: 35669595 PMCID: PMC9165703 DOI: 10.2147/ijgm.s364202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction An altered level of consciousness (ALOC) means that the patient is not as awake, alert, or able to understand or react to the surrounding environment. The main purpose of this study was to investigate the epidemiology, risk factors, and etiology of altered levels of consciousness among patients attending the Emergency Department. Methods The study was conducted in the Mogadishu-Somali-Turkey Training and Research Hospital in Mogadishu, Somalia, as a prospective observational study. A total of 155 adult patients with a GCS ≤12 were admitted to the emergency room for traumatic and non-traumatic ALOC between March and June 2021. Results Our study enrolled 155 (2.6%) of the 6000 patients hospitalized in the emergency room. 60% (n = 93) were males and 40% (n = 62) were females. The mean age of the participants was 46.7 ± 22.4 years. The most common presenting features were dyspnea (21.9%), injuries (20%), hemiplegia (16.8%), convulsion (16.8%), and oliguria (12.3%). 119 (77%) cases had a GCS = 3-8, while 36 (23%) had a GCS = 9-12. Most of the participants with ALOC had a history of hypertension (27.7%, n = 43), 34 (21.9%) had diabetes, 6 (3.9%) had epilepsy, and 4 (2.6%) had chronic renal disease. Cerebro-vascular-accidents (24.5%) were the most common cause of ALOC, followed by organ failure and traumatic brain injury (22% each), infections (12.2%), diabetic emergencies, hypoglycemia (11.6%), shock, and status epilepticus (4% each). Conclusion Male sex, older age, hypertension, and diabetes were the main risk factors for our study participants, while uremic encephalopathy, ischemic stroke, hemorrhagic stroke, sepsis syndrome, and subdural hematoma were the most common causes of ALOC.
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Affiliation(s)
- Hassan Adan Ali
- Emergency Department, Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia
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10
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van de Wint T, de Vries Schultink AHM, Meinders AJ, Harmsze A, Bruins P. Prolonged coma due to amitriptyline overdose and genetic polymorphism: a case report. J Med Case Rep 2022; 16:112. [PMID: 35296334 PMCID: PMC8925239 DOI: 10.1186/s13256-022-03294-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Reduced consciousness has a wide variety of possible causes, not infrequently being toxic in nature. An intoxication might be obvious, but in this paper an unexpected case with a tricyclic antidepressant is presented. Case presentation A 76-year-old caucasian female was found unconscious. Primary diagnostic evaluation, including a negative drugs of abuse test, did not give direction to any clear cause. Yet an intraventricular conductive disorder with widening of the QRS complex and electroencephalogram abnormalities did suggest a possible drug effect. Heteroanamnestic information led to the suspicion of an amitriptyline intoxication, which was confirmed by further laboratory analysis. The patient remained comatose for several days. High concentrations of amitriptyline indicated a large overdose of amitriptyline and, in combination with a cytochrome P450 2D6 poor metabolizer status, could explain the long persistence of her comatose state. Conclusion We present a tricyclic antidepressant intoxication, where the patient is thought to have taken a large amount of amitriptyline at once, which, in combination with a cytochrome P450 2D6 poor metabolizer status, led to an unusual long persistence of her coma.
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Affiliation(s)
- Tijs van de Wint
- Department of Anesthesiology, Intensive Care and Pain Management, St. Antonius Hospital, Amsterdam, The Netherlands.
| | | | - Arend Jan Meinders
- Department of Internal Medicine and Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ankie Harmsze
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Peter Bruins
- Department of Anesthesiology, Intensive Care and Pain Management, St. Antonius Hospital, Amsterdam, The Netherlands
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A retrospective cohort study on association of age and physician decision making for or against rapid sequence intubation in unconscious patients. Sci Rep 2022; 12:3336. [PMID: 35228569 PMCID: PMC8885918 DOI: 10.1038/s41598-022-06787-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 02/04/2022] [Indexed: 11/08/2022] Open
Abstract
In unconscious individuals, rapid sequence intubation (RSI) may be necessary for cardiopulmonary stabilisation and avoidance of secondary damage. Opinions on such invasive procedures in people of older age vary. We thus sought to evaluate a possible association between the probability of receiving prehospital RSI in unconsciousness and increasing age. We conducted a retrospective study in all missions (traumatic and non-traumatic) of the prehospital emergency physician response unit in Graz between January 1st, 2010 and December 31st, 2019, which we searched for Glasgow Coma Scale (GCS) below 9. Cardiac arrests were excluded. We performed multivariable regression analysis for RSI with age, GCS, independent living, and suspected cause as independent variables. Of the 769 finally included patients, 256 (33%) received RSI, whereas 513 (67%) did not. Unadjusted rates of RSI were significantly lower in older patients (aged 85 years and older) compared to the reference group aged 50-64 years (13% vs. 51%, p < 0.001). In multivariable regression analysis, patients aged 85 years and older were also significantly less likely to receive RSI [OR (95% CI) 0.76 (0.69-0.84)]. We conclude that advanced age, especially 85 years or older, is associated with significantly lower odds of receiving prehospital RSI in cases of unconsciousness.
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Rajsic S, Breitkopf R, Bachler M, Treml B. Diagnostic Modalities in Critical Care: Point-of-Care Approach. Diagnostics (Basel) 2021; 11:diagnostics11122202. [PMID: 34943438 PMCID: PMC8700511 DOI: 10.3390/diagnostics11122202] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023] Open
Abstract
The concept of intensive care units (ICU) has existed for almost 70 years, with outstanding development progress in the last decades. Multidisciplinary care of critically ill patients has become an integral part of every modern health care system, ensuing improved care and reduced mortality. Early recognition of severe medical and surgical illnesses, advanced prehospital care and organized immediate care in trauma centres led to a rise of ICU patients. Due to the underlying disease and its need for complex mechanical support for monitoring and treatment, it is often necessary to facilitate bed-side diagnostics. Immediate diagnostics are essential for a successful treatment of life threatening conditions, early recognition of complications and good quality of care. Management of ICU patients is incomprehensible without continuous and sophisticated monitoring, bedside ultrasonography, diverse radiologic diagnostics, blood gas analysis, coagulation and blood management, laboratory and other point-of-care (POC) diagnostic modalities. Moreover, in the time of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, particular attention is given to the POC diagnostic techniques due to additional concerns related to the risk of infection transmission, patient and healthcare workers safety and potential adverse events due to patient relocation. This review summarizes the most actual information on possible diagnostic modalities in critical care, with a special focus on the importance of point-of-care approach in the laboratory monitoring and imaging procedures.
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Affiliation(s)
- Sasa Rajsic
- General and Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (S.R.); (M.B.)
| | - Robert Breitkopf
- Transplant Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Mirjam Bachler
- General and Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (S.R.); (M.B.)
| | - Benedikt Treml
- General and Surgical Intensive Care Unit, Department of Anaesthesiology and Critical Care Medicine, Medical University Innsbruck, 6020 Innsbruck, Austria; (S.R.); (M.B.)
- Correspondence:
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Mulkey M, Everhart DE, Gencarelli A, Sorrell A, Kim S. A Review of Neuronal Pathways Associated With Consciousness. J Neurosci Nurs 2021; 53:39-43. [PMID: 33252410 PMCID: PMC8127025 DOI: 10.1097/jnn.0000000000000559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT INTRODUCTION: Accurate communication of information regarding fluctuations in level of consciousness is critical. It is, important for nurses to understand terms related to consciousness to appropriately assess and implement plans of care. CONTENT: Although the neurobiology of consciousness is complex and multifaceted, consciousness can be conceptualized as having 2 distinct but interrelated dimensions: arousal and awareness. The different levels of consciousness are thought to fall on a continuum ranging from being fully awake to coma. CONCLUSION: This article focuses on the terms of consciousness, awareness, and arousal along with nursing implications where appropriate.
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Ribeiro SCDC. Decreased Glasgow Coma Scale score in medical patients as an indicator for intubation in the Emergency Department: Why are we doing it? Clinics (Sao Paulo) 2021; 76:e2282. [PMID: 33681943 PMCID: PMC7920397 DOI: 10.6061/clinics/2021/e2282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sabrina Correa da Costa Ribeiro
- Emergencias Clinicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Akaishi T, Endo T, Hasebe M, Ishii T, Aoki M. Unilateral loss of oculocephalic response in a patient with hemispheric cerebral hemorrhage. Clin Neurol Neurosurg 2020; 198:106234. [PMID: 32971303 DOI: 10.1016/j.clineuro.2020.106234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan; Department of Education and Support for Regional Medicine, Tohoku University Hospital, Japan.
| | - Toshiki Endo
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center, Japan
| | | | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
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Cortical Function in Acute Severe Traumatic Brain Injury and at Recovery: A Longitudinal fMRI Case Study. Brain Sci 2020; 10:brainsci10090604. [PMID: 32899145 PMCID: PMC7563151 DOI: 10.3390/brainsci10090604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/22/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022] Open
Abstract
Differences in the functional integrity of the brain from acute severe brain injury to subsequent recovery of consciousness have not been well documented. Functional magnetic resonance imaging (fMRI) may elucidate this issue as it allows for the objective measurement of brain function both at rest and in response to stimuli. Here, we report the cortical function of a patient with a severe traumatic brain injury (TBI) in a critically ill state and at subsequent functional recovery 9-months post injury. A series of fMRI paradigms were employed to assess sound and speech perception, command following, and resting state connectivity. The patient retained sound perception and speech perception acutely, as indexed by his fMRI responses. Command following was absent acutely, but was present at recovery. Increases in functional connectivity across multiple resting state networks were observed at recovery. We demonstrate the clinical utility of fMRI in assessing cortical function in a patient with severe TBI. We suggest that hallmarks of the recovery of consciousness are associated with neural activity to higher-order cognitive tasks and increased resting state connectivity.
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Kurihara T, Igarashi Y, Kobai K, Mizobuchi T, Ishii H, Matsumoto N, Yokobori S, Yokota H. Diagnosis and prediction of prognosis for Bickerstaff's brainstem encephalitis using auditory brainstem response: a case report. Acute Med Surg 2020; 7:e517. [PMID: 32685172 PMCID: PMC7266809 DOI: 10.1002/ams2.517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/13/2020] [Accepted: 04/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background It is difficult to diagnose Bickerstaff’s brainstem encephalitis (BBE) in the acute phase, and emergency physicians could diagnose BBE as an unknown cause of consciousness disturbance. Case presentation A 75‐year‐old woman presented with dizziness and weakness in both arms 1 week after an upper respiratory infection. She experienced gradual worsening of consciousness, had dilated pupils and no light reflex. She was suspected of brainstem dysfunction at the upper part of the brainstem; however, there were not significant findings on magnetic resonance imaging, cerebrospinal fluid, or electroencephalography. The auditory brainstem response demonstrated a low voltage, but there was no prolonged latency. At a later date, she was diagnosed with BBE based on serum immunoglobulin G anti‐GQ1b antibody. She was discharged home without any neurological sequelae. Conclusion It is necessary to analyze serum immunoglobulin G anti‐GQ1b antibodies to diagnose BBE. Auditory brainstem response would be helpful in detecting lesions and predicting functional recovery.
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Affiliation(s)
- Toru Kurihara
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
| | - Kaori Kobai
- Department of Anesthesiology Wakayama Medical University Wakayama Japan
| | - Taiki Mizobuchi
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
| | - Hiromoto Ishii
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
| | - Noriko Matsumoto
- Department of Neurology Nippon Medical School Hospital Tokyo Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine Nippon Medical School Hospital Tokyo Japan
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