Etiology and clinical characteristics of patients with severely impaired consciousness in prehospital settings: a retrospective study

Abstract

Abstract Background: Although patients with severely impaired consciousness require a rapid response, it is commonly difficult to obtain detailed histories and perform accurate physical examinations of these patients. Therefore, this study examined the causes of patients with severely impaired consciousness and the clinical characteristics in prehospital settings that are useful for differential diagnosis. Methods: We conducted a single-center retrospective study using data from the Kobe City Fire Department database. We retrospectively examined patients aged ≥16 years with Japan Coma Scale III-digit codes during paramedic contact and transported them to our hospital between January 2018 and December 2018. Furthermore, we evaluated the age, systolic blood pressure (sBP), presence of airway obstruction, and mortality for each final diagnosis. Results: Overall, 227 patients were included in this study. One hundred and twelve patients (49.3%) were male, and the median age was 71 years (interquartile range 50–83 years). Stroke was the most common cause (30%). In addition, intoxication and psychiatric disorders were significantly more common in younger patients (P < 0.01). sBP was the highest inpatients with stroke. Airway obstruction was found most frequently in patients with stroke (73.5%), with a significant difference compared with other differential diseases,except for environmental disorders and cardiovascular diseases (P < 0.01). Mortality was the highest in stroke (55.9%), which was significantly higher than that for other differential diagnoses, except for environmental disorders and cardiovascular diseases.Among the patients with stroke, 45.6% had ocular abnormalities. Conclusion: Stroke was the most common cause of severely impaired consciousness. However, age, sBP, the presence of airway obstruction, and ocular abnormalities can be useful indicators for differential diagnosis in prehospital settings in patients with severe disturbance of consciousness.