Aim To present the findings of the Decreased Conscious Level Multi-site Audit which examined selected recommendations from the RCPCH-endorsed guideline: The Management of a Child with a Decreased Conscious Level. Methods 51 NHS trusts collected data on consecutive cases of children less than 18 years who presented acutely 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 1147 cases, of which 1132 met the audit's inclusion/exclusion criteria. Results Trusts performed well for the documentation of heart rate (50/51, 98.0%) and to a lesser degree for respiratory rate (37/51, 72.5%), oxygen saturation (46/51, 90.2%) and the use of either Glasgow Coma Scale or AVPU scale to assess the level of consciousness (46/51, 90.2%). However, the documentation of blood pressure (11/51, 21.6%) and temperature (31/51, 60.8%) was of a poorer standard. In the majority of trusts, there was a failure to meet the audit standards for the recommended clinical history features which should be elicited from these children and young people. Very few trusts met the performance targets for the documentation of the presence or absence of the following clinical history features: vomiting (4/51, 7.8%), fever (4/51, 7.8%), convulsions (4/51, 7.8%), alternating periods of consciousness (11/51, 21.6%), trauma (2/51, 3.9%), ingestion of medication or recreational drugs (2/51, 3.9%) and length of symptoms (23/51, 45.1%). Measurement of capillary glucose only met the standard in 18/48 (37.5%) trusts. Although, no performance targets were set for these areas, the majority of the trusts failed to achieve even a minimum level of 75% or more. There were low levels of documentation on whether parents were allowed to stay with their child (9/51, 17.6%), informed regarding their child's possible diagnosis (13/51, 25.5%) and possible prognosis (8/51, 15.7%). Conclusions There were significant gaps in the documentation of observations, clinical history, investigations and communication with parents in the care of children and young people presenting acutely with a recognised decreased conscious level. A revised guideline will aim to address these issues.
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.
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 GCS grades for decreased conscious level Cases Total = 900 Severe: ≤ 8 203 (22.6%) Moderate: 9-12 221 (24.6%) Mild: 13-15 476 (52.8%) 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 Age (years) Cases 0-0.1 (neonates) 3.7% 0.2-1 20.7% 1.1-5 17.3% 5.1-13 21.9% 13.1-17.9 36.2% 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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