Documentation of Altered Mental Status

Status

Completed

Phases

Unknown

Study type

Observational

Source

ClinicalTrials.gov

Registry ID

NCT03040843

Enrollment

1200

Registered

2017-02-02

Start date

2017-01-31

Completion date

2017-06-30

Last updated

2017-09-21

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Altered Level of Consciousness

Keywords

documentation, altered mental status, definition, clinically

Brief summary

Altered mental status (AMS) is common in older patients. However there is a lack of standardization in the definition and documentation of this compliant. Different perception of AMS can cause negative impact on interpretation and obtaining scientific data. Although definition of AMS is so complicated, clinical documentation can be detected in these patients with AMS.

Detailed description

Basically, consciousness is the state of full awareness of the self and one's relationship to the environment. There are 2 related areas of neurologic function that are connected to consciousness: content (orientation and memory) and level (arousal and response to stimuli). The mental changes are best looked for in terms of arousal, attention, alertness, orientation, cognition, memory, affect, and perception. Arousal (level of consciousness) can be detected by the Richmond Agitation and Sedation Scale. Others are related to content of consciousness and can be evaluated by cognitive tests. After one month pilot study, the investigators chose 5 features of content of consciousness due to easy applicable and detectable; 1. Attention (counting numbers backwards from 20) (\>1 error positive) 2. Cognition (disorganized thinking; meaningless speech, irrelevant explanations) 3. Perception (visual or auditory hallucinations) 4. Memory (3 items recall) (\>1 error positive) 5. Orientation (day of week, month and year) (\>1 error positive) These features are also combination of six item screener test and delirium symptoms. All elderly patients (65 aged and older) presented to the emergency department, will be assessed according to these two methods; content and level of consciousness. And also, every patient's baseline status of consciousness will be obtained from surrogates who knows the patient best. All changes from patient's baseline status will be recorded. The investigators will investigate how changes are reflected in the clinic.

Interventions

None listed

Study design

Observational model

COHORT

Time perspective

PROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

65 Years to 110 Years

Healthy volunteers

Inclusion criteria

* All older ED patients

Exclusion criteria

* Unknown baseline status, any trauma, and unable to assess mental status due to acute clinical condition (STE MI, severe dyspnea, etc)

Design outcomes

Primary

Measure	Time frame	Description
Detection of impaired level of consciousness in older ED patients	First 30 minute of presentation to the emergency department	Arousal (level of consciousness) measured by the Richmond Agitation and Sedation Scale.
Detection of impaired content of consciousness in older ED patients	First 30 minute of presentation to the emergency department	Awareness (content of consciousness) measured by the 5 criteria list questionnaire.

Secondary

Measure	Time frame
Mortality	1 and 3 month mortality after patient enrolled

Countries

Turkey (Türkiye)

Outcome results