Table 1 Descriptive information from included studies of reduced level of arousal and mortality
Author and country | Year | Study type | Unselected medical/ disease specific | Mean age (SD) | Total N | Reduced Level of arousal n (%) | Total deaths n (%) | Arousal scale/ description |
|---|---|---|---|---|---|---|---|---|
Prospective studies using an arousal scale with unselected patients | ||||||||
āAslaner et al Turkey | 2017 | Prospective cohort | Unselected: ED admissions with altered mental status | 77 (70-83) median with IQR | 822 | 632 (76.9) | 203 (24.7) | RASS: -4 and -5 versus -3,-2 and -1 versus 0,+1,+2,+3,+4 |
āRathour et al India | 2015 | Prospective cohort | Unselected: admissions with sepsis | 50.5 (16.3) | 200 | 46 (23) | 116 (58) | GCS: ā¤9 versus >9 |
āNavinan et al Sri Lanka | 2013 | Prospective cohort | Unselected: medical unit admissions | 50.7 | 167 | Not given | 10 (6.0) | GCS: mean |
āFrancia et al Spain | 2009 | Prospective cohort | Unselected: admissions to medicine ward | 73.6 (16.8) | 500 | Not given | 65 (13) | GCS: mean |
āBurch et al S. Africa | 2008 | Prospective cohort | Unselected: medical admissions from ED | 45.4 (17.0) | 469 | Not given | 113 (24.1) | AVPU: A versus VPU |
āDuckitt et al England | 2007 | Prospective cohort | Unselected: medical admissions to an emergency unit | 72.4 (range 17-106) | 4286 | Not given | 355 (8.3) | AVPU: A versus VPU |
Prospective studies using an arousal scale with specific medical conditions | ||||||||
āNicolini et al Italy | 2014 | Prospective cohort | Respiratory: COPD | 77.1 | 207 | Not presented | 33 (15.9) | Kelly Matthay Scale: From (1) alert to (6) comatose |
āOtieno et al Kenya | 2010 | Prospective cohort | Endocrine: Diabetic ketoacidosis | 33.4 (15.2) | 47 | 28 (59.6) (11 = GCS 9-12, 17 = GCS 3-6) | 14 (29.8) | GCS: 13-15 versus 9-12 (drowsy) versus 3-8 (coma/ obtunded) |
āDutta et al India | 2008 | Prospective cohort | Endocrine: Myxoedema coma | 59.5 (14.8) | 23 | Not presented | 12 (52.2) | GCS: mean |
āDelahaye et al France | 2007 | Prospective cohort | Cardiology: Infective endocarditis | 59 (16.8) | 559 | Not presented | 95 (17) | GCS: 9-15 versus 3-8 |
Prospective studies not using an arousal scale for specific medical conditions | ||||||||
āCalle et al Spain | 2014 | Prospective cohort | Respiratory: Community acquired pneumonia | 85.4 (6.4) | 456 | 61 (13.5) | 110 (24.2) | āaltered level of consciousnessā |
Retrospective studies using an arousal scale with unselected patients | ||||||||
āBarfod et al Denmark | 2012 | Prospective cohortb | Unselected: admissions from ED | Not given | 6279 | 197 ( 3.1) | 107 (1.7) | GCS: ā¤ 13 versus >13 |
āMyint et al England | 2011 | Prospective cohorta | Unselected: medical nursing home admissions | 83.8 (8.4) | 316 | Not given | 78 (24.7) | GCS: cut-offs not presented |
Retrospective studies using an arousal scale for specific medical conditions | ||||||||
āSakamoto et al Japan | 2017 | Retrospective cohort | Respiratory: COPD | 76 (8.9) | 3064 | 393 (12.8) | 209 (6.8) | JCS: alert, dull, somnolent, coma |
āKaya et al Turkey | 2016 | Retrospective cohort | Gastrointestinal bleeding | 62 (25) | 600 | 21 (3.5) | 38 (6.3) | GCS: 15 versus <15 |
āHasegawa et al Japan | 2015 | Retrospective cohort | Vasculitis: Churg Strauss | 61.9 (15.6) | 2195 | 96 (4.4) | 97 (4.4) | JCS: alert versus non alert |
āYamauchi et al Japan | 2015 | Retrospective cohort | Respiratory: Asthma/COPD/asthma-COPD mix | 68.9 (14) | 30405 | 2771 (9.1) | 794 (2.6) | JCS: alert, dull, somnolent, coma. |
āChih-Hsun et al Taiwan | 2001 | Retrospective cohort | Endocrine: Hyperglycaemic, hyperosmolar non-ketotic state | 67.8 (11.7) | 119 | 89 (74.8) (54 GCS 9-14, 38 GCS 3-8) | 29 (24.4) | GCS: mean |
Retrospective studies not using an arousal scale for specific medical conditions | ||||||||
āConte et al USA | 1999 | Retrospective cohort | Respiratory: Community acquired pneumonia | Not given, all over 65 | 1000 | 80 (8) | 87 (8.7) | Eye opening: spontaneous versus not. Verbal: orientated versus not. Motor: to voice versus not |
āOnadeko et al Kuwait | 2005 | Retrospective cohort | Respiratory: COPD | 63.7 (12.6) | 74 | 18 (24.3) | 14 (18.9) | Descriptive terms: ādrowsyā versus āalertā |
āZweig et al USA | 1990 | Retrospective cohort | Respiratory: Pneumonia | 80 (no SD) | 133 | 65 (48.9) non-alert | 21 (15.8) | Categories: alert, confused, arousable, comatose |