Sathirapanya Pornchai, Smitasin Naris, Limapichart Kitti, Setthawatcharawanich Suwanna, Phabphal Kanitpong
Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
J Med Assoc Thai. 2009 Sep;92(9):1131-5.
Altered consciousness (AC) is a common presenting problem in the Emergency Department (ED), the causes of which can be either intracranial or extracranial in origin.
To determine the common etiologies of AC among patients in the ED of a medical teaching hospital and to build up a proper differential diagnosis.
A retrospective review of the medical records of patients who presented with AC in the ED between January and August 2004 was conducted Patient characteristics and demographic data as well as the etiologies of AC were presented in descriptive pattern.
There were 350 patients, of whom 67 (19.1%) were admitted, 38(10.9%) were transferred to other hospitals due to full occupancy, 35 (10%) died in the ED, and the rest (60%) were discharged and re-evaluated The mean age was 60.3 years old with 57.1% males and 42.9% females. The etiologies included neurological disorders (29.1%), endocrine/metabolic derangement (20.8%), infectious diseases and sepsis (18.8%), cardiovascular disorders (10%), psychiatric illness (8.8%), pulmonary (7.1%), and toxicological causes (5.1%).
Though neurological disorders or intracranial causes were the most common etiology of AC in the ED, they accounted for only one-third of all cases in the ED. The larger proportion of AC cases was extracranial abnormalities including adverse effects from current medications.
意识改变（AC）是急诊科（ED）常见的就诊问题，其病因可能源于颅内或颅外。
确定某医学教学医院急诊科患者AC的常见病因，并建立恰当的鉴别诊断。
对2004年1月至8月在急诊科出现AC的患者病历进行回顾性研究。患者特征、人口统计学数据以及AC的病因以描述性方式呈现。
共有350例患者，其中67例（19.1%）入院，38例（10.9%）因满员转至其他医院，35例（10%）在急诊科死亡，其余（60%）出院并接受重新评估。平均年龄为60.3岁，男性占57.1%，女性占42.9%。病因包括神经系统疾病（29.1%）、内分泌/代谢紊乱（20.8%）、传染病和脓毒症（18.8%）、心血管疾病（10%）、精神疾病（8.8%）、肺部疾病（7.1%）以及毒理学原因（5.1%）。
虽然神经系统疾病或颅内病因是急诊科AC最常见的病因，但它们仅占急诊科所有病例的三分之一。AC病例中较大比例是颅外异常，包括当前药物的不良反应。
