Altered Mental Status: An Exploration of Definitions and Descriptors in the Literature

Objectives: To examine the use of “altered mental status” in studies addressing states of shock, by reviewing published English literature. We explored how the term is defined and described in the literature, and alternative words/phrases used. Background: Assessment of mental status is crucial for patients in shock and life-threatening conditions. The term “altered mental status” is being used inconsistently, and varied means of assessment have been reported, which may have implications for critical care nurses' training and implementation of clinical practice guidelines. Methods: A systemized literature review based on targeted searches in CINAHL and MEDLINE, with predefined eligibility criteria. Primary studies, reviews and case studies were included. Results: Based on eligibility criteria, 92 articles were included (48 primary studies, 32 case reports, 12 review articles). Glasgow Coma Scale (GCS) was most frequently used to define “altered mental status” followed by the terms “unconsciousness”, “confusion” “coma” and “disorientation”. Changes in consciousness were described in a variety of expressions, i.e. decreased level of consciousness, change in awareness, and GCS. Conclusion: There is no universal definition for altered mental status. More work is needed towards an accurate definition standardization of use of related terms, and consensus on the most valid assessment methods in order to identify patients with high risk for deterioration.