Characteristics of children and young people presenting acutely with a decreased conscious level (multi-site audit 2010-2011)

Abstract

<h3>Aim</h3> To describe the characteristics of children and young people presenting to hospital with reduced consciousness reported in the Decreased Conscious Level Multi-site Audit. <h3>Methods</h3> 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 audit9s inclusion criteria. <h3>Results</h3> The mean age at presentation was 8.3 years (standard deviation = 6.3 years) with a median age of 8 years (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. 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%). <h3>Conclusions</h3> 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.