Key result
Among older adults presenting with altered mental status who underwent lumbar puncture, 26.5% were diagnosed with meningitis/encephalitis, which could not be differentiated by clinical characteristics alone.
Why the study?
Altered mental status is a challenging diagnosis, prompting an evaluation of underlying causes, laboratory, microbiological, and imaging findings, and infectious processes in older patients presenting with it.
What are the underlying causes and diagnostic findings of altered mental status in older adults undergoing lumbar puncture in the emergency department?
Observational (n=98)
No
What are the underlying causes and diagnostic findings of altered mental status in older adults undergoing lumbar puncture in the emergency department?
Clinical characteristics alone are insufficient to differentiate meningitis/encephalitis from other causes of altered mental status in older adults, necessitating CSF analysis and cranial imaging.
LP remains essential for older adults with altered mental status; this Level 3 cohort study leaves open optimal selection criteria.
Objective: Altered mental status (AMS) is challenging diagnosis.It was aimed to evaluate the underlying causes, reveal laboratory, microbiological and imaging findings, and determine the infectious process in older patients who presented with AMS. Materials and Methods:This retrospective study was conducted at a training and research hospital.Sixty-five year and older patients who presented with AMS and underwent lumbar puncture, were included.Results: Among 98 older patients with AMS, the median age was 75.0 years (interquartile range: 69.0-75.0)and 58.2% of patients were female.Of the patients, 26.5% meningitis/encephalitis, 33.6% other infection sources, and 39.8% other disorders were found, respectively.Cerebrospinal fluid (CSF) white blood cell and protein levels were found higher; CSF chloride levels were detected lower in meningitis/encephalitis group.In brain, magnetic resonance imaging (p<0.001) and electroencephalogram (p=0.009) were found more pathologies suggesting infection in meningitis/ encephalitis patients, while brain computed tomography revealed no differences between meningitis/encephalitis and other diagnoses group.The need for intensive care was higher in the other disorder group (p=0.02)while admission to service was higher in the meningitis/encephalitis group (p=0.03). Conclusion:Clinical characteristics failed to differentiate between meningitis/encephalitis and other diagnoses in older patients with AMS, and CSF analysis, cranial imaging methods were required for the final diagnosis.
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Ayaz et al. (2023) conducted an observational in Altered mental status (n=98). Meningitis/encephalitis vs. Other diagnoses was evaluated on Diagnosis of meningitis/encephalitis. Among older adults presenting with altered mental status who underwent lumbar puncture, 26.5% were diagnosed with meningitis/encephalitis, which could not be differentiated by clinical characteristics alone.
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