Pharmacoepidemiological study in patients with non-traumatic altered sensorium at tertiary care hospital

Abstract

Background: Non-traumatic altered sensorium (NTAS) is a critical condition with diverse etiologies, presenting significant diagnostic and therapeutic challenges, particularly in resource-limited settings.

Objective: To evaluate the clinical features, etiologies, drug utilization patterns, and treatment outcomes of NTAS in a tertiary care hospital.

Methods: This six-month prospective observational study at Teerthanker Mahaveer Hospital, Moradabad, India, enrolled 272 patients aged >18 years with NTAS lasting >4 hours, excluding those with transient unresponsiveness or pre-existing cognitive disorders. Data on demographics, clinical characteristics, diagnostic investigations, etiologies, and outcomes were analyzed.

Results: The cohort (52.2% male, 47.8% female; 60% urban, 40% rural) was primarily aged 18–45 years. Metabolic disorders were the most common etiology, followed by infections, CNS disorders, and drug-induced causes. Sepsis presented severe symptoms (85% confusion, 70% lethargy), while metabolic and drug-induced cases were milder. Blood glucose testing (77.2%) and neuroimaging (CT: 47.8%, MRI: 43.4%) were frequent, but EEG use was low (6.6%). Polypharmacy was prevalent (40.07% on 4–6 drugs), increasing adverse drug reaction risks. Recovery rates were highest for withdrawal cases (98%) and lowest for sepsis (50% recovery, 30% mortality).

Conclusion: Effective NTAS management requires early diagnosis, etiology-specific treatments, and pharmacovigilance. Limited EEG use and high polypharmacy underscore the need for enhanced diagnostics and rational prescribing to improve outcomes in resource-constrained settings.