Clinical Characteristics, Etiologies, and Outcomes of Adults Presenting With Altered Mental Status to the Emergency Department: A Retrospective Cohort Study

BackgroundAltered mental status (AMS) is a common emergency presentation with diverse neurological, infectious, metabolic, toxicological, and systemic causes. ObjectiveThe objective of this study was to describe the clinical characteristics, underlying etiologies, management patterns, and clinical outcomes of adults presenting to the emergency department with AMS, and to identify independent clinical factors associated with in-hospital mortality. MethodsThis retrospective cohort study was conducted at Allama Iqbal Teaching Hospital, Dera Ghazi Khan, Pakistan, from April 2024 to April 2026 and included 210 adult patients presenting with AMS.Demographic and baseline clinical characteristics, including age, gender, body mass index, smoking status, presenting symptoms, duration of AMS, known comorbidities, medication history, substance use, and relevant previous neurological or systemic illnesses, were recorded. ResultsOf 210 patients, 174 (82.9%) survived, and 36 (17.1%) died.The mean age was 61.74±16.64years, and 118 (56.2%) were male.Neurological causes were most common (29.0%), followed by infectious (21.4%), metabolic/endocrine (16.2%), and toxicological causes (11.9%).Non-survivors were older than survivors (72.10±13.80 vs. 59.60±16.40years, p<0.001) and had lower Glasgow Coma Scale (GCS) scores (6.90±3.20 vs. 11.60±3.10,p<0.001), lower oxygen saturation (89.10±8.00% vs. 94.60±4.40%,p<0.001), and higher serum lactate levels (4.80±2.70 vs. 2.30±1.60 mmol/L, p<0.001).Intensive care unit (ICU) admission was required in 61 (29.0%) patients, while 42 (20.0%)required mechanical ventilation. ConclusionAltered mental status was associated with considerable ICU utilization and in-hospital mortality.Neurological and infectious causes predominated, while severe impairment of consciousness, elevated lactate, hypoxemia, hypotension, infectious etiology, and advanced age were independently associated with increased odds of mortality.