Using vital signs to diagnose impaired consciousness: cross sectional observational study

Ikeda, Masayuki; Matsunaga, Takashi; Irabu, Noritsugu; Yoshida, Shohji

doi:10.1136/bmj.325.7368.800

Cited by 31 publications

(27 citation statements)

References 13 publications

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“…This nding is supported by previous studies. Ikeda et al reported that high sBP was associated with brain lesions accounting for impaired consciousness observed in patients with AMS [11], and higher BT was associated with infectious diseases such as sepsis in other studies [12,13].…”

Section: Discussionmentioning

confidence: 86%

Vital signs effectively predict non-hypoglycaemia in patients with altered mental status in pre-hospital settings: A retrospective analysis

Mizu

Matsuoka

Huh

et al. 2020

Preprint

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BackgroundBlood glucose (BG) measurement by paramedics for patients with altered mental status is recommended as pre-hospital care in Japan. Therefore, paramedics prioritise BG measurement over transport to hospital even in emergency conditions such as hypotension or hypoxaemia. The purpose of this study was to examine the relationship between BG levels and vital signs, and to evaluate whether vital signs are effective in determining the necessity of BG measurement in pre-hospital settings. MethodsWe extracted data of patients who had BG measurements performed by paramedics in Kobe City from April 2015 to March 2019. We retrospectively investigated patient age, sex, presence of hypoglycaemia (BG level < 50 mg/dL) and vital signs. If a patient did not have hypoglycaemia and was transported to the Kobe City Medical Centre General Hospital, a final diagnosis was obtained. Patients aged below 15 years, and those with BG measurement errors, missing vital sign data, or a Japan Coma Scale 0 and I-digit codes were excluded. The χ2 test and Mann-Whitney U test were used for statistical analysis, and P<0.05 was considered statistically significant. ResultsOf the 1,791 patients, 1,242 were eligible for analysis (mean age, 71.9 years; 805 [58%] male). Hypoglycaemia was observed in 324 patients (26.1%). Of the 918 non-hypoglycaemic patients, 253 (27.6%) were transported to our hospital and stroke was the most common final diagnosis (61 patients [24.1%]). The non-hypoglycaemic group had more elderly patients than the hypoglycaemic group (median 73 vs. 76 years; P < 0.01). A significant difference in each vital sign were noted between hypoglycaemic and non-hypoglycaemic groups, with body temperature showing the highest difference between groups (area under the curve, 0.71; 95% confidence interval [CI], 0.68-0.74). Furthermore, in cases with systolic blood pressure being over 100 mmHg and body temperature being 38°C or less, it was highly unlikely that hypoglycaemia caused impaired consciousness (likelihood ratio 0.12 and 0.16; 95% CI 0.05-0.25 and 0.06-0.35, respectively). ConclusionWhen considering pre-hospital hypoglycaemia assessment, vital signs are an effective index. If patients have significant hypotension or high fever, paramedics should consider immediate transport rather than BG measurement.

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Section: Discussionmentioning

confidence: 86%

Vital signs effectively predict non-hypoglycaemia in patients with altered mental status in pre-hospital settings: A retrospective analysis

Mizu

Matsuoka

Huh

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…EDITOR—We agree with Ikeda et al that the absence of systolic hypertension may provide some discriminatory power towards exclusion of brain lesions, be they ischaemic, haemorrhagic, or space occupying in nature 1. However, we disagree with them that neurological examination of patients with impaired consciousness is often a waste of time and resources and can delay diagnosis.…”

mentioning

confidence: 78%

Drug misuse should always be considered in young people with impaired consciousness

Whelan

2003

BMJ

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“…15 Ikeda et al reported that vital signs are useful for diagnosing brain lesions in patients with impaired consciousness. 16 DBP distinguishes patients with impaired consciousness who are at high risk of an organic brain lesion from those who are at low risk.…”

Section: Discussionmentioning

confidence: 99%

Using Diastolic Blood Pressure to Diagnose Acute Stroke in Isolated Acute Vestibular Syndrome

Matsumoto

Kishikawa

Okuyama

et al. 2016

J of Gen and Family Med

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Background: Although diagnosis of isolated acute vestibular syndrome (AVS) via physical examination has been reported, a great deal of experience is needed to interpret the results. Patients with AVS often cannot participate in a physical examination, and not every emergency department (ED) is equipped with a magnetic resonance imaging machine. Therefore, in isolated AVS, clinical factors other than those used by general physicians and/or residents are required to identify strokes in these patients. The aim of this study was to determine those clinical factors useful in differentiating stroke patients from isolated AVS patients in the ED setting. Methods:We examined the records of 116 consecutive patients who presented to the ED between May 2010 and April 2013 with AVS (acute vertigo or dizziness, nystagmus, nausea/vomiting, head-motion intolerance, unsteady gait) and without auditory symptoms, head and/or neck pain, or neurological findings. Patients underwent diagnostic neuroimaging. Clinical characteristics and vital signs measured in the ambulance were assessed. Multivariate logistic regression analysis was performed to evaluate the associations of systolic blood pressure (SBP) ²150 mmHg, diastolic blood pressure (DBP) ²85 mmHg, heart rate, age ²60 years, and dyslipidemia with stroke.Results: Stroke was diagnosed in eight of the 116 (6.9%) patients with isolated AVS. DBP ²85 mmHg (odds ratio 29.0; 95% confidence interval 3.38-249) was the only significant and independent factor associated with stroke among patients with isolated AVS. Journal of General and Family Medicine 2016, vol. 17, no. 3, p. 218-224. Original Articles -218 -Conclusion: This study identified DBP ²85 mmHg to be a simple and useful clinical factor differentiating stroke from non-stroke isolated AVS.

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Using vital signs to diagnose impaired consciousness: cross sectional observational study

Cited by 31 publications

References 13 publications

Vital signs effectively predict non-hypoglycaemia in patients with altered mental status in pre-hospital settings: A retrospective analysis

Vital signs effectively predict non-hypoglycaemia in patients with altered mental status in pre-hospital settings: A retrospective analysis

Drug misuse should always be considered in young people with impaired consciousness

Using Diastolic Blood Pressure to Diagnose Acute Stroke in Isolated Acute Vestibular Syndrome

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