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Recovery position significantly associated with a reduced admission rate of children with loss of consciousness
  1. Sebastien Julliand1,
  2. Marie Desmarest2,
  3. Leticia Gonzalez3,
  4. Yolanda Ballestero4,
  5. Abel Martinez5,
  6. Raffaella Moretti6,
  7. Aristides Rivas7,
  8. Laurence Lacroix8,
  9. Armand Biver9,
  10. Emilie Lejay2,
  11. Lakshmi Kanagarajah10,
  12. Nancy Portillo4,
  13. Giovanni Crichiutti6,
  14. Chiara Stefani11,
  15. Liviana Da Dalt11,
  16. Daniele Spiri12,
  17. Patrick Van De Voorde13,
  18. Luigi Titomanlio2
  1. 1Pediatric Mobile Service for Emergencies and Resuscitation, Robert Debré Hospital, Paris Diderot University, Paris, France
  2. 2Pediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Paris, France
  3. 3Pediatric Emergency Department, Rio Hortega Hospital, Valladolid, Spain
  4. 4Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain
  5. 5Pediatric Emergency Department, Barcelona University Hospital, Spain
  6. 6Pediatric Emergency Department, University of Udine, Udine, Italy
  7. 7Pediatric Emergency Department, Gregorio Marañon General Univerisity Hospital, Madrid, Spain
  8. 8Pediatric Emergency Department, Geneva University Hospital, Switzerland
  9. 9Pediatric Emergency Department, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
  10. 10Basildon University Hospital, Essex, UK
  11. 11Pediatric Emergency Department, University of Padova and Treviso Hospital, Italy
  12. 12Pediatric Emergency Department, Milan University Hospital, Italy
  13. 13Pediatric Emergency Department, Ghent University Hospital, Ghent, Belgium
  1. Correspondence to Dr Luigi Titomanlio, Pediatric Emergency Department, Robert Debré Hospital—Assistance Publique Hôpitaux de Paris (APHP), Paris Diderot University, Sorbonne Paris Cité, 48, Bld Sérurier— Paris 75019, France; luigi.titomanlio{at}


Background Loss of consciousness (LOC) is often seen in children. The response of caregivers to a child with LOC has been poorly investigated. Potential caregivers (parents, teachers) seem to have a poor knowledge of the recovery position (RP)—that is, the position into which an unconscious child should be placed in order to protect the airway.

Objectives To report the management and diagnoses of LOC in childhood, and to evaluate variables associated with an increased hospital admission rate.

Methods We conducted a prospective cohort study of consecutive children aged between 0 and 18 years diagnosed with LOC at 11 paediatric emergency departments (PEDs) of 6 European countries. The enrolment period was 3 months. Data were obtained from parental interviews, PED reports and clinical examination.

Results 553 children were enrolled. The most frequent final diagnoses causing LOC were seizures (n=278, 50.3%), and vasovagal syncope (n=124, 22.4%). Caregivers put the child in the RP in 145 cases (26.2%). The RP was independently associated with a significant decrease in the admission rate (aOR=0.28; 95% CI 0.17 to 0.48; p<0.0001).

Conclusions Our study demonstrates for the first time that the RP may reduce the admission rate of infants with LOC. Caregivers often perform inadequate manoeuvres when a child becomes unconscious. Campaigns aiming at increasing knowledge of the RP should be promoted.

  • Accident & Emergency
  • Comm Child Health

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