|
PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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Round one
4. History of
illness
Statement 4a (Features in the history)
In children with reduced level of consciousness, the following features should be elicited from the history to determine the investigations and treatment required:
(i) vomiting before or at presentation
|
%
Agree |
%
Disagree |
Result |
|
91.9% |
0% |
Included |
|
Position |
Comments |
|
ED |
Should this statement be split into 2 statements? ie if GCS 8 or less, treatment precedes investigations – this may be true if GCS 9-14 too! ABC is the resuscitation + treatment of immediately life threatening problems and no Ix needed. |
|
PICU |
nature of , content, … |
(ii) headache before or at presentation
|
%
Agree |
%
Disagree |
Result |
|
97.4% |
0% |
Included |
|
Position |
Comments |
|
PICU |
especially time of onset/waking |
(iii) fever before or at presentation
|
%
Agree |
%
Disagree |
Result |
|
100% |
0% |
Included |
(iv) fitting before or at presentation
|
%
Agree |
%
Disagree |
Result |
|
100% |
0% |
Included |
|
Position |
Comments |
|
Neuro |
I dislike the term ‘fitting’ as it is imprecise |
|
PICU |
pattern/duration |
(v) alternating periods of consciousness
|
%
Agree |
%
Disagree |
Result |
|
100% |
0% |
Included |
|
Position |
Comments |
|
PICU |
timing/duration |
(vi) trauma
|
%
Agree |
% Disagree |
Result |
|
100% |
0% |
Included |
(vii) ingestion of medications or recreational drugs
|
%
Agree |
%
Disagree |
Result |
|
100% |
0% |
Included |
(viii) the presence of any medications in the child’s home
|
%
Agree |
%
Disagree |
Result |
|
89.2% |
0% |
Included |
|
Position |
Comments |
|
Paed |
Or the environment in which the child spent time preceding admission eg grandparents home |
|
Renal |
Needs to be considered but in practice would depend on the age of the child |
|
Paed |
Questioning on accessibility of any medication is important |
(ix) consanguinity of parents
|
%
Agree |
%
Disagree |
Result |
|
57.1% |
2.9% |
Excluded |
|
Position |
Comments |
|
Paed |
Very context specific. Highly unlikely to be relevant to older developentally normal children with good history of trauma. Perhaps restrict to certain age range eg under 2 yo |
|
Renal |
Much less so with a child over 5 |
|
Endo |
In certain situations eg in infancy, likelihood of metabolic conditions, ie no clear history |
(x) any previous infant deaths in family
|
%
Agree |
%
Disagree |
Result |
|
85.7% |
2.9% |
Included |
|
Position |
Comments |
|
Paed |
Very context specific. Highly unlikely to be relevant to older developentally normal children with good history of trauma. Perhaps restrict to certain age range eg under 2 yo |
|
Renal |
Much less so with a child over 5 |
|
Biochem |
Not just deaths, but unexplained illnesses in siblings and extended family if they are consanguinous |
|
Neuro S |
Is it a fair time to ask parents this in resus? |
|
Endo |
Especially in younger children, unless other cause seems likely from history/examination |
|
PICU |
and stillbirths |
(xi) length of symptoms
|
%
Agree |
%
Disagree |
Result |
|
97.3% |
0% |
Included |
Statement 4b
Non-accidental injury or other child protection issues may be behind the cause of reduced consciousness in children
|
%
Agree |
%
Disagree |
Result |
|
100% |
0% |
Included |
|
Position |
Comments |
|
Paed |
Again, much more likely in infants or children unable to defend themselves from major trauma than teenagers |
|
Neuro |
The likelihood of this is strongly age-dependant |
|
Renal |
Not sure about the wording of this – I can’t see that you can answer anything other than 9 |
|
ED P |
Must at least be considered, especially in infants |
|
Radiol |
“small children” |
|
PICU |
important to record history given promptly, be clear about timing and witnesses to conscious level. Child last agreed to be well = |
|
Paed |
register check. signs of harm |