The management of children presenting with decreased conscious level

Summary 

A child with a decreased conscious level poses many difficult questions for emergency practitioners and paediatricians. Frequently, there are very few specific clinical signs to establish the cause in individual patients. Therefore, successful management depends on early appropriate investigation to determine the underlying diagnosis. One of the difficulties is knowing which tests to undertake in which patients. Thinking about the rarer treatable causes at the onset will lead to a faster recognition of this small but important group of patients. Specific treatments will depend on the underlying problem but supportive measures need to be instituted whilst awaiting the diagnosis. A guideline for practitioners in the UK has been published to help junior and senior frontline staff, who may encounter children with a decreased conscious level. This article is based around the recommendations in this guideline and aims to highlight best practice for these patients, who are at risk of significant mortality and morbidity.

Keywords: Coma, Infant, Child, Adolescent, Intracranial pressure, Brain diseases, Metabolic