Decreased consciousness level in children: management of

An evidence-based guideline for health professionals based in the hospital setting. Nationally developed by The Paediatric Accident and Emergency Research Group.

Entry criteria

The following algorithm should be used for children aged 0 – 18 years who present to hospital with a
reduced level of consciousness. This is defined as scoring <15 on the Glasgow Coma Scale (GCS)
modified for children or responding only to voice, pain or being unresponsive on the AVPU scale.
Ensure the child is maximally roused from sleep before recording conscious level.

Exclusion criteria

Infants on a neonatal intensive care unit.
Children with a known condition for episodes of reduced conscious level (e.g. epilepsy, diabetes) where a management plan is already agreed upon.
Children with learning disabilities, whose score on the GCS is <15 when they are healthy.

In certain children with reduced conscious level, it may be appropriate to watch and wait. However, if a decision is made to stick a needle into a child to investigate the cause, take all the samples listed as “core investigations” at the first opportunity.