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Table 1 Descriptive information from included studies of reduced level of arousal and mortality

From: Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis

Author and country Year Study type Unselected medical/ disease specific Mean age (SD) Total N Reduced Level of arousal n (%) Total deaths n (%) Arousal scale/ description
Prospective studies using an arousal scale with unselected patients
 Aslaner et al Turkey 2017 Prospective cohort Unselected: ED admissions with altered mental status 77 (70-83) median with IQR 822 632 (76.9) 203 (24.7) RASS: -4 and -5 versus -3,-2 and -1 versus 0,+1,+2,+3,+4
 Rathour et al India 2015 Prospective cohort Unselected: admissions with sepsis 50.5 (16.3) 200 46 (23) 116 (58) GCS: ≤9 versus >9
 Navinan et al Sri Lanka 2013 Prospective cohort Unselected: medical unit admissions 50.7 167 Not given 10 (6.0) GCS: mean
 Francia et al Spain 2009 Prospective cohort Unselected: admissions to medicine ward 73.6 (16.8) 500 Not given 65 (13) GCS: mean
 Burch et al S. Africa 2008 Prospective cohort Unselected: medical admissions from ED 45.4 (17.0) 469 Not given 113 (24.1) AVPU: A versus VPU
 Duckitt et al England 2007 Prospective cohort Unselected: medical admissions to an emergency unit 72.4 (range 17-106) 4286 Not given 355 (8.3) AVPU: A versus VPU
Prospective studies using an arousal scale with specific medical conditions
 Nicolini et al Italy 2014 Prospective cohort Respiratory: COPD 77.1 207 Not presented 33 (15.9) Kelly Matthay Scale: From (1) alert to (6) comatose
 Otieno et al Kenya 2010 Prospective cohort Endocrine: Diabetic ketoacidosis 33.4 (15.2) 47 28 (59.6) (11 = GCS 9-12, 17 = GCS 3-6) 14 (29.8) GCS: 13-15 versus 9-12 (drowsy) versus 3-8 (coma/ obtunded)
 Dutta et al India 2008 Prospective cohort Endocrine: Myxoedema coma 59.5 (14.8) 23 Not presented 12 (52.2) GCS: mean
 Delahaye et al France 2007 Prospective cohort Cardiology: Infective endocarditis 59 (16.8) 559 Not presented 95 (17) GCS: 9-15 versus 3-8
Prospective studies not using an arousal scale for specific medical conditions
 Calle et al Spain 2014 Prospective cohort Respiratory: Community acquired pneumonia 85.4 (6.4) 456 61 (13.5) 110 (24.2) ‘altered level of consciousness’
Retrospective studies using an arousal scale with unselected patients
 Barfod et al Denmark 2012 Prospective cohortb Unselected: admissions from ED Not given 6279 197 ( 3.1) 107 (1.7) GCS: ≤ 13 versus >13
 Myint et al England 2011 Prospective cohorta Unselected: medical nursing home admissions 83.8 (8.4) 316 Not given 78 (24.7) GCS: cut-offs not presented
Retrospective studies using an arousal scale for specific medical conditions
 Sakamoto et al Japan 2017 Retrospective cohort Respiratory: COPD 76 (8.9) 3064 393 (12.8) 209 (6.8) JCS: alert, dull, somnolent, coma
 Kaya et al Turkey 2016 Retrospective cohort Gastrointestinal bleeding 62 (25) 600 21 (3.5) 38 (6.3) GCS: 15 versus <15
 Hasegawa et al Japan 2015 Retrospective cohort Vasculitis: Churg Strauss 61.9 (15.6) 2195 96 (4.4) 97 (4.4) JCS: alert versus non alert
 Yamauchi et al Japan 2015 Retrospective cohort Respiratory: Asthma/COPD/asthma-COPD mix 68.9 (14) 30405 2771 (9.1) 794 (2.6) JCS: alert, dull, somnolent, coma.
 Chih-Hsun et al Taiwan 2001 Retrospective cohort Endocrine: Hyperglycaemic, hyperosmolar non-ketotic state 67.8 (11.7) 119 89 (74.8) (54 GCS 9-14, 38 GCS 3-8) 29 (24.4) GCS: mean
Retrospective studies not using an arousal scale for specific medical conditions
 Conte et al USA 1999 Retrospective cohort Respiratory: Community acquired pneumonia Not given, all over 65 1000 80 (8) 87 (8.7) Eye opening: spontaneous versus not. Verbal: orientated versus not. Motor: to voice versus not
 Onadeko et al Kuwait 2005 Retrospective cohort Respiratory: COPD 63.7 (12.6) 74 18 (24.3) 14 (18.9) Descriptive terms: ‘drowsy’ versus ‘alert’
 Zweig et al USA 1990 Retrospective cohort Respiratory: Pneumonia 80 (no SD) 133 65 (48.9) non-alert 21 (15.8) Categories: alert, confused, arousable, comatose
  1. apaper stated both prospective and retrospective- prospective data collection but reviewed the information retrospectively
  2. bpaper stated prospective, but we considered it to be retrospective as it extracted data from a previously populated database
  3. Level of arousal: Level of Arousal
  4. JCS Japan Coma Scale