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Management of children and young people with an acute decrease in conscious level (RCPCH guideline update 2015)
  1. Sarah Reynolds1,
  2. Dilshad Marikar2,
  3. Damian Roland2
  1. 1 Department of Neonatal, John Radcliffe Hospital, Oxford, UK
  2. 2 Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Cardiovascular Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Dr Dilshad Marikar, Paediatric Emergency Medicine Leicester Academic (PEMLA) group, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK; dilshad.marikar{at}

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About this guideline

This guideline provides an evidence and expert consensus-based framework to assess and manage paediatric patients aged 4 weeks–18 years with a decreased conscious level of unknown cause.1 It was produced by the Royal College of Paediatrics and Child Health (RCPCH) and is endorsed by the National Institute for Health and Care Excellence (NICE), Royal College of Nursing (RCN) and College of Emergency Medicine (CEM). It updates previous guidance produced in 20052 to reflect evidence of changes in the demographics of children presenting to emergency settings with a decreased conscious level.3

The guideline provides a general overview of management, and readers are directed to national guidelines for detailed management of specific conditions (see box 1 for resources examples).

The following patient groups are not included in this guideline:

  • neonates

  • preterm infants on neonatal intensive care units

  • children with a known medical condition which can cause decreased conscious level (eg, epilepsy), where an agreed management plan is in place for acute illness

  • children with a daily baseline score of Glasgow Coma score (GCS) of <14 (eg, children with epileptic encephalopathy or minimally responsive state following acquired brain injury).

Box 1


  • The management of children and young people with an acute decrease in conscious level—full RCPCH guideline and algorithm poster


NICE guidelines

  • Head injury: assessment and early management


  • Sepsis: recognition, diagnosis and early management


  • Meningitis (bacterial) and meningococcal septicaemia in under 16: recognition, diagnosis and management


  • Epilepsy in children and young people


  • Child maltreatment: when to suspect maltreatment in under 18


Other Guidelines

  • Hypoglycaemia: investigation and management: British Inherited Metabolic Diseases Group


  • Diabetic ketoacidosis (DKA): British Society of Endocrinology and Diabetes


  • Stroke in childhood: Royal College of Paediatrics and Child Health


  • Practice standards for young people with substance misuse problems: Royal …

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  • Contributors DM and SR: initial manuscript draft. DM and DR: manuscript revisions.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Correction notice This paper has been amended since it was published Online First. The author order has been changed with Sarah Reynolds now being the first author.