The impact of alcohol on conscious level in children and young people

Abstract

Aims Recent published data from industrialised countries suggests an increase in prevalence of young children and adolescents presenting to hospital with alcohol intoxication. The aim of this abstract is to present the findings of the children and young people presenting to hospital with a decreased conscious level secondary to alcohol intoxication 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 the emergency department or paediatric assessment unit with a decreased conscious level between the period: 1 November 2010 to 30 September 2011. These trusts used either a wholly retrospective or a combined prospective/retrospective approach to identify the cases. Data was collected on 1132 eligible cases of which 315 presented with a decreased conscious level secondary to alcohol intoxication. Results All 315 cases of alcohol intoxication were included. The majority of these cases presented on a weekend (194/315, 61.6%) as compared to a week-day (121/315, 38.4%). The mean age at presentation is 14.7 years (standard deviation= 1.6 years). The median age is 15 years. There were slightly higher numbers of female (172/315, 54.6%) as compared to male cases (143/315, 45.4%). 3/315 (1.0%) were intubated. All cases had either AVPU or GCS used to assess their conscious level. In the 288/315 cases who had GCS performed the mean GCS was 11 (standard deviation = 3) and the median was 13. 55/288 (19.1%) cases had a GCS of 8 or less at presentation (table 1). In 128/315 (40.6%) cases, the child or young person was reviewed by either a consultant or a doctor of ST4 grade or higher. The majority of the cases were discharged home (223/315, 70.8%) while the remainder were either transferred to the ward (85/315, 27.0%), transferred to PICU (3/315, 1.0%) or self-discharged (3/315, 1.0%). Conclusions There is a significant risk of developing coma in young people presenting with alcohol intoxication. Diagnosis of alcohol intoxication should be considered for older children and adolescents presenting to Emergency departments with reduced conscious level.