Altered mental status in cancer-related emergency hospitalizations: prevalence and recorded reasons for admission

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BACKGROUND: Altered mental status is a critical clinical presentation in emergency departments, yet its frequency in cancer-related emergency hospitalizations and the clinical conditions recorded at presentation have not been well characterized. METHODS: We conducted a retrospective multicenter cohort study using data from the Cancer Registry-based Study on Cancer Care in Osaka (CanReCO), which links hospital-based cancer registry data with Diagnosis Procedure Combination (DPC) administrative data. The cohort included patients diagnosed between January 2019 and December 2022, and linked DPC hospitalization records available through June 2023 were used to identify first emergency hospitalizations after cancer diagnosis. We extracted cases presenting with altered mental status, defined as a Japan Coma Scale score ≥ 1. Recorded reasons for admission were described overall and according to cancer stage and cancer type. RESULTS: Of 55,949 cancer-related emergency hospitalizations across 68 participating hospitals, 5,881 (10.5%) involved altered mental status. The most frequent reasons for admission among patients with altered mental status were index cancer (32.3%), stroke (8.6%), and pneumonia (6.9%). When analyzed by cancer stage at diagnosis, index cancer, CNS metastasis, and sepsis were more frequently recorded in later stages. When analyzed by cancer type, certain reasons were more frequent in specific malignancies, including CNS metastasis in lung and breast cancers; pneumonia in lung cancer; sepsis in hematologic, pancreatic, and biliary cancers; and hyperglycemia or diabetes mellitus in pancreatic cancer, among others. CONCLUSIONS: Altered mental status was commonly recorded among cancer patients requiring emergency hospitalization. The reasons for admission varied by cancer stage and cancer type, with neurological and infectious diagnoses frequently observed. These findings provide descriptive information that may help clinicians consider cancer-specific patterns when evaluating cancer patients presenting with altered mental status in emergency settings.

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