Use of formal coma assessment scales and approaches to management in non-traumatic conditions associated with altered consciousness.
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Date
2006Author
Njuguna, Patricia W
Type
ThesisLanguage
enMetadata
Show full item recordAbstract
Altered consciousness states are a recognised sign of severity of childhood illnesses.
Timely identification of altered consciousness states and appropriate immediate
management is important and impacts on outcome.
Objective:
To describe the use of formal coma scales for the assessment of altered consciousness
states, staff knowledge on scales and appropriate investigations and the actual use of
simple investigations in children admitted with serious, non-traumatic illness
commonly associated with neurological impairment
Study design:
A prospective record review (n=170) was carried out in Kenyatta National Hospital. A
nested reassessment of level of consciousness was carried out on forty children. A
staff knowledge assessment (n=51) was carried out.
Results:
Overall 170 case records were reviewed. On admission, assessment using the
Glasgow coma scale was used in eight percent and 38.9% in the mortality group.
When an assessment of consciousness was made, clinicians were more comfortable
using AVPU scale (41%) than the Glasgow coma scale (26%) for the assessment.
According to locally applicable standards a lumbar puncture was indicated in one
hundred and twenty eight children (75.1% of all child records reviewed) but
performed on fifty six children (32.5%) while only five (9%) were performed within
an appropriate time period. A random blood sugar was performed on fifty six children
(32.9%); it was identified as an appropriate immediate investigation by twenty four
clinicians (82.8%) while a lumbar puncture was identified by four clinicians (14%) as 8
an immediate investigation in a febrile child with altered consciousness not due to
trauma.
Conclusions:
Assessment of level of consciousness using the Glasgow coma scale is rarely used in
practice; rather general and potentially misleading descriptive terms are used.
Amongst children with clear indications for simple investigations to establish the
cause for altered consciousness and / or assist in its treatment only a blood slide is
commonly performed with a lumbar puncture rarely performed appropriately. The
quality of care of children admitted to Kenyatta National hospital with altered
consciousness would benefit from defining and implementing standard management
guidelines.
URI
http://ctf.kemri-wellcome.org/dissertations/MMed_2006_Njuguna_PW.pdfhttp://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/42958
Citation
Masters of Medicine degree in Paediatrics and Child health,Publisher
KEMRI Department of Pediatrics, University of Nairobi,