Context

Children presenting to an emergency department (ED) with decreased consciousness pose many diagnostic and management challenges. There is evidence that in cases of non-traumatic coma with Glasgow Coma Score (GCS) <12 for >6 hours, patients have a high morbidity and mortality.

The differential diagnosis is wide and this session provides an overview of the main causes.

Decreased consciousness is a non-specific sign with a wide differential diagnosis. Causes may include (but are not limited to):

• Shock: hypovolaemic, distributive and cardiogenic
• Sepsis
• Trauma
• Intracranial infection
• Epilepsy
• Poisoning
• Raised intracranial pressure
• Metabolic disease
• Hypertension

Delays by the emergency physician to identify these causes, select appropriate investigations and initiate treatment can have devastating consequences for the child.

Simultaneous resuscitation, diagnosis and treatment should be initiated within the first hour after presentation. [1]

The goals are to stabilise, establish the cause of decreased consciousness and prevent deterioration. [2]