{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T09:25:05Z","timestamp":1766395505314,"version":"3.48.0"},"reference-count":0,"publisher":"Jaypee Brothers Medical Publishing","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAPI"],"published-print":{"date-parts":[[2025,12,10]]},"abstract":"<jats:p>Introduction: Nontraumatic cases of impaired\/altered sensorium continue to be one of the most \nfrequent emergencies that casualties encounter. The patient\u2019s overall prognosis may depend on \nearly clinical evaluation and etiological diagnosis. In order to make a more accurate and timely \ndiagnosis, it is crucial to understand the etiological profile of comatose patients who arrive at a \ntertiary care facility, which can successfully predict the outcome.\nMaterials and methods: This prospective observational study was carried out in a South Indian tertiary \ncare facility. A total of 126 patients with altered mental status of nontraumatic origin who arrived at \nthe emergency room with Glasgow coma scale (GCS) scores below 10 were included in the study.\nResults: Of the 126 patients, 48 (38.1%) were female and 78 (61.9%) were male. All patients were \n52.65 \u00b1 17.94 years old on average. The comorbidities observed in this study were hypertension \n(49.2%), diabetes mellitus (36.5%), alcoholism (33.3%), smoking (25.3%), coronary artery disease \n(CAD) (7%), chronic kidney disease (CKD) (9.5%), epilepsy (4.7%), and previous cerebrovascular \naccident (CVA) (9.5%). The presenting symptoms other than altered sensorium were fever (4%), \nvomiting (9.5%), headache (3%), motor weakness (16%), seizures (15.8%), and breathlessness \n(4.7%). About 36 patients (28.5%) had abnormal neurological examination, with motor weakness \nbeing the most common finding in 34 patients (27%). A brain magnetic resonance imaging (MRI) \nor computed tomography (CT) scan was performed on 104 patients (82.5%), and 50 patients \n(48%) had abnormal results. The commonest finding was cerebral and cerebellar infarction seen \nin 35 patients (33.6%). A number of 48 (38%) patients had abnormal electrocardiogram (ECG), 42 \n(33%) had nonspecific ischemic alterations, and six patients (4.7%) had atrial fibrillation. In our \nstudy, 46 patients (36.5%) had neurological causes of impaired\/altered sensorium, 32 patients \n(25.4%) had metabolic causes, 18 patients (14.3%) had multifactorial causes, 14 patients (11.1%) \nhad infections, and 16 patients (12.7%) had other causes [status epilepticus, drug overdose, \norganophosphate (OP) poisoning]. The commonest neurological cause was ischemic stroke, \nnoted in 32 patients (69.5%), out of which 16 cases were posterior circulation strokes. About \n14 cases had anterior circulation stroke. The remaining two cases presented with both anterior \nand posterior circulation strokes. The mortality rate was 36.5%. A number of 46 patients died \nout of 126 patients. Out of 46 patients, CVA was the most common cause of death, accounting \nfor 20 cases (43.4%).\nConclusion: In this study, the duration of altered mental status, GCS score, level of altered \nconsciousness, and etiology were found to be significant prognostic markers that correlated \nwith outcome in nontraumatic cases with impaired\/altered sensorium. Factors that offer early \nprognostic information can help with resource allocation decisions because the cost of intensive \ncare has increased significantly. The prognosis can be predicted using a simple clinical evaluation \nof neurological function, paying particular attention to the degree of consciousness, focal \nneurological signs, and brainstem reflexes.<\/jats:p>","DOI":"10.59556\/japi.73.1278","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T09:22:21Z","timestamp":1766395341000},"page":"34-36","source":"Crossref","is-referenced-by-count":0,"title":["A Study of the Etiology, Clinical Profile, and Outcome of  Nontraumatic Cases of Impaired\/Altered Sensorium in Patients  Attending the Emergency Department in a South Indian  Tertiary Care Hospital"],"prefix":"10.59556","volume":"73","author":[{"given":"Usharani","family":"Budumuru","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sowmini","family":"PR","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pramod","family":"KS","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malcolm","family":"Jeyaraj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sakthi","family":"Velayutham","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kannan","family":"Vellaichamy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saravanan V","family":"Raju","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mugundhan","family":"Krishnan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2914","published-online":{"date-parts":[[2025,12,10]]},"container-title":["Journal of the Association of Physicians of India"],"original-title":[],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T09:22:22Z","timestamp":1766395342000},"score":1,"resource":{"primary":{"URL":"https:\/\/japi.org\/article\/japi-73-12-34"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,10]]},"references-count":0,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,10]]},"published-print":{"date-parts":[[2025,12,10]]}},"URL":"https:\/\/doi.org\/10.59556\/japi.73.1278","relation":{},"ISSN":["0004-5772"],"issn-type":[{"value":"0004-5772","type":"print"}],"subject":[],"published":{"date-parts":[[2025,12,10]]}}}