Acute presentation of altered conscious state

Abstract

<h2>Abstract</h2> Children present to healthcare services with a range of disorders of altered consciousness. Some are benign and self-resolving but others will be rapidly fatal if untreated. Moreover, the most likely diagnosis is not always obvious. Children and young people have a wider range of causes than adults and the limited language skills of younger children increase the diagnostic challenge. The clinician is faced with a number of competing and overlapping priorities. They must be able to rapidly assess the child, prioritise their management and investigations, whilst also coordinating appropriate and timely specialist referrals. At the same time, they need to be able to communicate these plans with their teams, the child and often a very stressed or distressed family. In order to do this effectively, it is necessary to have a toolkit in place which includes knowledge, skills and a clear road-map. This mini-review will equip the reader with a highly structured and practical approach to the child or young person with altered consciousness and it follows the recommendations set out by the Royal College of Paediatrics and Child Health. It considers in detail some of the more important differential diagnoses and outline the principles of management.