Guidelines for the investigation and management of a reduced level of consciousness in children: implications for clinical biochemistry laboratories

Ann Clin Biochem 2007;44:506-511
doi:10.1258/000456307782268228
© 2007 Association for Clinical Biochemistry

 

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Review Article


R Bowker,
A Green and
J R Bonham


Academic Department of Child Health, Queen’s Medical Centre, Nottingham, UK;
Department of Clinical Chemistry, Birmingham Children’s Hospital, Birmingham, UK;
Department of Clinical Chemistry, Sheffield Children’s (NHS) Foundation Trust, Sheffield S10 2TH, UK

Whenever a child presents to hospital with a reduced level ofconsciousness, admitting clinicians have to decide the underlyingcause rapidly so that the correct emergency treatment can beinitiated. Unfortunately, the clinical presentations of manyof the possible diagnoses are very similar. The diagnosis oftenresults from investigations within the clinical biochemistrylaboratory. In the past, clinicians have had limited guidanceon which tests to request when presented with a child with areduced level of consciousness. Guidelines have recently beendeveloped relating to all aspects of management of the childin a coma. Due to a lack of evidence in the literature regardingthe most appropriate first line tests for children with a reducedlevel of consciousness, a formal consensus process (‘Delphiconsensus’) was performed using a large multidisciplinary panelof experts. The recommendations reached by this process includethe list of initial (‘core’) tests to request for all childrenwith a reduced level of consciousness (excluding those immediatelyafter suffering a convulsion and those involved in obvious trauma).Depending upon the results of these ‘core’ tests and the clinicalcondition of the child, further tests may be requested later.The key point is that all the samples have been taken at thetime of presentation to provide the best chance of reachinga diagnosis and correctly treating the child. The article reviewsthe recommended core investigations and further tests and discusseshow individual laboratories can help to implement the guidelinesjointly with their Emergency and Paediatric Departments.


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