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PAEDIATRIC ALTERED
CONSCIOUS LEVEL GUIDELINE |
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Round three
16. No clinical clues to cause
16 (ii) The following additional tests should be requested if, after reviewing the core investigations’ results, the cause of a child’s reduced conscious level remains unknown:
CT scan
a lumbar puncture (if no acute contraindications exist)
urine toxicology screen
urine organic acids
plasma lactate
|
Position |
Comment |
|
Chem |
I am a bit confused why acyl carnitines and amino acids are not in this list. Specimens for as many tests as possible should be collected – decision about which tests to do can be at a later stage |
|
Paed ED |
I would agree with above, but I would classify CT scan as
core |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
96% |
4% |
0% |
16 (ii) In a child with a reduced conscious level with an unknown cause after reviewing the core investigations, CT scan and initial CSF results, the following tests should be considered:
(c) an EEG, organised as soon as possible, to exclude non-convulsive status epilepticus
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
100% |
% |
% |
(f) urine amino acids, in children less than 5 years old
|
Position |
Comment |
|
Metab |
Not likely to be very useful and takes too long to get a result usually not available on-call |
|
paed |
Not a practical point in a DGH situation i.e. the result wont be available for a few days |
|
chem |
urine and plasma amino
acids, * Why less than 5 years? We had an adult presenting with
encephalopathy with a urea cycle disorder. Important to do urine and plasma. |
|
PICU |
not sure about 5 yr cut off |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
91% |
9% |
0% |
(h) acyl-carnitine profile (on Guthrie card or from stored frozen plasma)
|
Position |
Comment |
|
paed |
Should there be an age limit? 5 -ish ? I would certainly do in young children but not in previously normal teenagers |
|
chem |
Guthrie not a recognised
description. Should be ‘screening blood spot
card’ or something similar |
|
PICU |
?any upper age limit |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
95% |
5% |
0% |
(j) ESR and autoimmune screen, to exclude cerebral vasculitidis
|
Position |
Comment |
|
paed |
An ESR and autoimmune screen will NOT exclude cerebral vasculitis If you want to EXCLUDE it you would have to do an MRIangio. |
|
Paed ED |
If history of headaches +/- other signs of vasculitis |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
86% |
14% |
0% |
(k) Thyroid function test and thyroid antibodies, to exclude Hashimoto’s encephalitis
|
Position |
Comment |
|
metab |
No experience here; don’t know the incidence/ likelihood unlike those in the 3 o4 scenarios above… |
|
paed |
I am not sure that hashimoto is a very common entity in Paeds |
|
Paed ED |
Must be very rare! |
|
Neuro |
auto antibodies! It is so rare and normally presents with psychosis so I’m not sure of the cost-benefit analysis |
|
Agreed |
Neither agree nor disagree |
Disagreed |
|
86% |
10% |
4% |