Evaluation and cost analysis of non-traumatic patients over 65 years of age presenting to the emergency department with consciousness impairment

Elderly patients are more frequently seen in emergency departments compared to other age groups, forming a significant portion of emergency visits. Age-related decreases in organ and system capacities complicate adaptation to various stress factors, increasing susceptibility to chronic illnesses and complications. This leads to heightened needs for diagnostic tests and consultations, increased mortality and morbidity rates, prolonged emergency department stays, and elevated costs of emergency care. Our study aims to evaluate the diagnostic processes and cost analysis in the emergency department for patients over 65 presenting with altered consciousness, identifying the etiological factors contributing to this condition. The study plans to classify cost analysis based on the causes of altered consciousness and assess its relationship with patient outcomes. This is a single-center retrospective study including 453 patients. We recorded patients' demographic characteristics, comorbidities, GCS scores, laboratory parameters, and etiological factors of altered consciousness. The emergency department outcomes, length of stay, and costs for these patient groups were examined. It was observed that 69.09% of the patients were aged between 65-84, with 55.63% being female. Hypertension and diabetes were the most common comorbidities. Mild altered consciousness was present in 58.41%, with 58.98% due to systemic causes. The majority of patients (66%, n=299) concluded with intensive care admissions. Most patients (38.85%, n=177) stayed in the emergency department for 4-8 hours. 91.81% underwent central imaging. The majority (57.84%, n=262) incurred moderate cost. Patients with systemic causes for altered consciousness had longer emergency department stays compared to those with central causes. It was evident that patient outcomes and central imaging significantly influenced the emergency department costs. Elderly patients with non-traumatic altered consciousness presented high intensive care admission rates, prolonged emergency department stays, and increased emergency care costs. We believe that collaborative decision-making between emergency physicians and administrative units in hospitals regarding the geriatric patient population presenting to emergency departments, and planning for their transfer from emergency services to appropriate hospital wards or intensive care units following essential investigations and interventions, can reduce hardships for patients and their families, and decrease the workload of emergency service staff.