|
PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
|||||||||
Round one
10. Trauma
Statement 10a (Trauma recognition and initial management)
In a child with reduced conscious level, evidence of trauma should be elicited from the history and examination.
|
%
Agree |
%
Disagree |
Result |
|
100% |
0% |
Included |
|
Position |
Comments |
|
PICU |
+ careful note made of Hx including timing by all staff |
|
Metab |
History in NAI, notoriously unreliable |
Statement 10b
A child with reduced conscious level and evidence of trauma should be further managed according to Advanced Paediatric Life Support and the NICE Head injury guidelines.
|
%
Agree |
%
Disagree |
Result |
|
87.5% |
9.4% |
Included |
|
Position |
Comments |
|
ED |
BUT 1. APLS is derived from ATLS principles – trauma Mx on the APLS course is 1/3rd of the whole course ie you need an experienced ATLS person included early in trauma; 2. the NICE guidelines are the ideal ie if we follow them no other patients would be scanned! |
|
|
The nice guidelines have very low thresholds for CT which are based on adult practice. A consideration of the paediatric age group that is involved should be made |
|
Metab |
I’m not familiar with NICE head injury guidelines |
|
ED P |
NICE leads to increased numbers of children having CT scans so I practise a “modified” NICE guideline |
|
Metab |
Confirm applies to children and to young babies(ie <12 months old) |
|
Radiol |
NICE H/I guidelines NO – APLS Yes |
|
Endo |
But presumably these would need to be included in guidelines if stated |
|
PICU |
helpful guidelines. may be incorporated in local guideline |
|
Paed |
some of the NICE advice contradictory |
Statement 10c
In a child with reduced consciousness and evidence of trauma
from a collapse, the core investigations should be requested to detect an
underlying medical cause in the child. (“core investigations” will be defined as the investigations
agreed upon in Statement 7d)
|
%
Agree |
%
Disagree |
Result |
|
79.4% |
8.8% |
Included |
|
Position |
Comments |
|
Paed |
I think one could be selective eg elecs and glucose on all, other metabolic might be omitted |
|
ED |
not an easy statement to unpick ie ?cause of collapse in child |
|
Neuro |
Unlikely to all be pertinent in this context, unless I’ve misunderstood what you’re driving at – is this traumatic encephalopathy? Badly worded |
|
Metab |
I am not sure that I understand this question |
|
ED P |
May need to be modified slightly, although many still required |
|
Paed |
If you mean trauma secondary to decreased conscious level then yes |
|
Endo |
Again no need for metabolic investigations if trauma likely cause |
|
Metab |
Meaning too vague. Do you mean in shock? |