ReviewThe western journal of emergency medicine2018
Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care.
Review in The western journal of emergency medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Adult Patients with Respiratory Distress: Current Evidence-based Recommendations for Prehospital Care.The western journal of emergency medicine · 2020Guideline
- Ambulance patients with altered level of consciousness: a registry-based cohort study from the North Denmark Region in 2017-2021.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Observational
- Pupillary Responses and Vital Signs in Hypoglycemic Patients with Impaired Consciousness During Prehospital Care: A Retrospective Observational Study.Diagnostics (Basel, Switzerland) · 2025Article
- Acute opioid overdose in pediatric patients.Journal of the American College of Emergency Physicians open · 2024Article
- Quality improvement tools to manage emergency callbacks from patients with diabetes in a prehospital setting.BMJ open quality · 2023Article
- Scenarios to improve CT head utilization in the emergency department delineated by critical results reporting.Emergency radiology · 2022Article
- Effect of pre-hospital early intervention combined with an in-hospital emergency model in the emergency care of patients with acute stroke.American journal of translational research · 2022Article
- A clinical decision rule predicting outcomes of emergency department patients with altered mental status.Journal of the American College of Emergency Physicians open · 2021Article
- Moyamoya as a Cause of Altered Mental Status in the Emergency Department: A Case Report.Clinical practice and cases in emergency medicine · 2021Article
- The accuracy of initial diagnoses in coma: an observational study in 835 patients with non-traumatic disorder of consciousness.Scandinavian journal of trauma, resuscitation and emergency medicine · 2021Observational
- Pediatric respiratory distress: California out-of-hospital protocols and evidence-based recommendations.Journal of the American College of Emergency Physicians open · 2020Article
- A potential method of identifying stroke and other intracranial lesions in a prehospital setting.Scandinavian journal of trauma, resuscitation and emergency medicine · 2020Article
- Clinico-etiological profile of the elderly population with altered mental status in a teaching hospital.Annals of African medicineObservational
- High fever or hypotension predicts non-hypoglycemia in patients with impaired consciousness in prehospital settings.Acute medicine & surgeryArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionIn the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California.
methodsWe performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management.
resultsProtocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol.
conclusionProtocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.
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