Using vital signs to diagnose impaired consciousness: cross sectional observational study

Abstract Objectives : To determine whether any vital signs can be used to quickly identify brain lesions in patients with impaired consciousness. Design : Cross sectional observational study. Setting : Emergency department of an urban hospital, Japan. Participants : 529 consecutive patients (mean age 65 years) presenting with impaired consciousness (score Main outcome measures : The receiver operating characteristic curve was used to quantify the relation between the vital signs on arrival and the final diagnosis of a brain lesion. Stratum specific likelihood ratios were calculated to define strata with optimal discriminating power. Results : 312 (59%) had a brain lesion which accounted for the impaired consciousness. The area under the receiver operating curve for systolic blood pressure was 0.90 (SE 0.01), indicating significantly higher accuracy (P Conclusions : Systolic blood pressure is useful for diagnosing brain lesions in patients with impaired consciousness.