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PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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Round one
15. Post-convulsive state
Statement 15a (Post-convulsion state)
(i) After a convulsion has stopped, a child will often have a period of reduced consciousness, the “post-convulsion state”
|
%
Agree |
%
Disagree |
Result |
|
97.1% |
2.9% |
Included |
|
Position |
Comments |
|
Neuro |
All this talk of ‘convulsions’ could do with clarification. I suspect we are talking about a GTCS |
(ii) The post convulsion state will last for less than one hour in the majority of children
|
%
Agree |
%
Disagree |
Result |
|
75.8% |
3.0% |
Included |
|
Position |
Comments |
|
|
often less than an hour but the family should be asked what the patient’s pattern is |
(iii) During the first hour of the post-convulsion state, a detailed history and examination should be performed
|
%
Agree |
%
Disagree |
Result |
|
78.8% |
3.0% |
Included |
|
Position |
Comments |
|
Radiol |
Before that + repeat within the hour |
(iv) During the first hour of the post-convulsion state, it may be appropriate to observe the child without any tests or treatments being sent
|
%
Agree |
%
Disagree |
Result |
|
62.5% |
21.9% |
Discussed
in round 2 |
|
Position |
Comments |
|
Metab |
I would still do a glucose |
|
Neuro |
I think an hour is too long, especially after a febrile seizure – we have data on this if you would like to see it. |
|
ED |
Some but not all investigations initiated during first hour |
|
Neuro |
not always |
|
Metab |
Caution! This v much assumes that no other/additional features (spots/eye signs, high temp) are present and that improved GCS present |
|
Radiol |
Glucose |
(v) After the first hour of the post-convulsion state, if the child has not recovered normal consciousness the core investigations (“core investigations” are those agreed upon in statement 7e) should be performed
|
% Agree |
%
Disagree |
Result |
|
81.3% |
0% |
Included |
|
Position |
Comments |
|
ED |
easier to answer when “core investigations” agreed |
|
Paed |
May be some exceptions depending on past history etc |
|
Paed |
Depends if the child well known to seize for prolonged periods and prolonged post-ictal state |