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Characteristics of children and young people presenting acutely with a decreased conscious level (multi-site audit 2010-2011)
  1. SA Smith1,
  2. CN Long2,
  3. G Denney3,
  4. J Gray4,
  5. M Lakhanpaul5,
  6. I Macononchie6,
  7. L Oates2,
  8. A Rashid1,
  9. R Slater6
  1. 1Paediatrics, Nottingham Children's Hospital, Nottingham, UK
  2. 2RCPCH, London, UK
  3. 3National Reyes Syndrome Foundation, Woking, UK
  4. 4Royal College of Nursing, London, UK
  5. 5University of Leicester, Leicester, UK
  6. 6Emergency Department, St Mary's London, UK

Abstract

Aim To describe the characteristics of children and young people presenting to hospital with reduced consciousness reported in the Decreased Conscious Level Multi-site Audit.

Methods 51 NHS trusts collected data on consecutive cases of children less than 18 years who presented to their emergency department or paediatric assessment unit with a decreased conscious level between the period: 1 November 2010 to 30 September 2011. The cases were identified using either a retrospective or a combined prospective/retrospective approach. Data was collected on 1147 cases, of which 1132 met the audit's inclusion criteria.

Results The mean age at presentation was 8.3 years (standard deviation = 6.3 years) with a median age of 8 years (table 2).

Abstract G309(P) Table 2

There were 620/1132 (54.7%) males and 512/1132 (45.2%) females reported.

1096/1132 (96.8%) cases had either AVPU or GCS (Glasgow Coma Scale) used to assess their conscious level. In the 900 cases who had GCS performed, the mean GCS was 11 (standard deviation = 4) and the median was 13. 203/900 (22.6%) cases had a GCS of 8 or less at presentation (table 1) and a total of 176/1132 (15.5%) required intubation.

Abstract G309(P) Table 1

The most common working diagnoses among the cases were alcohol intoxication (311/1132, 27.5%), infective causes (217/1132, 19.2%), trauma (176/1132, 15.6%) and febrile seizure (117/1132, 10.3%). 61.0% (690/1132) cases were reviewed by either a consultant or a doctor of ST4 grade or above in paediatrics or emergency medicine.

There were 16 (1.4%) deaths among the 1132 cases. The reminder of the cases were either discharged home (470/1132, 41.5%), transferred to the ward (478/1132, 42.2%), transferred to PICU (111/1132, 9.8%) or transferred to another hospital for acute services (46/1132, 4.1%).

Conclusions Decreased conscious level is a multi-factorial condition affecting children and young people of all ages. A significant proportion of these children will require resuscitation and ongoing care in hospital.

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