TY - JOUR T1 - Management of children and young people with an acute decrease in conscious level (RCPCH guideline update 2015) JF - Archives of disease in childhood - Education & practice edition JO - Arch Dis Child Educ Pract Ed DO - 10.1136/archdischild-2016-310574 SP - edpract-2016-310574 AU - Dilshad Marikar AU - Sarah Reynolds AU - Damian Roland Y1 - 2017/10/12 UR - http://ep.bmj.com/content/early/2017/10/12/archdischild-2016-310574.abstract N2 - 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.3The 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:neonatespreterm infants on neonatal intensive care unitschildren with a known medical condition which can cause decreased conscious level (eg, epilepsy), where an agreed management plan is in place for acute illnesschildren 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 ResourcesThe management of children and young people with an acute decrease in conscious level—full RCPCH guideline and algorithm posterhttp://www.rcpch.ac.uk/improving-child-health/clinical-guidelines-and-standards/published-rcpch/management-children-and-youNICE guidelinesHead injury: assessment and early managementhttps://www.nice.org.uk/guidance/cg176Sepsis: recognition, diagnosis and early managementhttps://www.nice.org.uk/guidance/ng51?unlid=280104107201611917351Meningitis (bacterial) and meningococcal septicaemia in under 16: recognition, diagnosis and managementhttps://www.nice.org.uk/guidance/cg102Epilepsy in children and young peoplehttps://www.nice.org.uk/guidance/qs27Child maltreatment: when to suspect maltreatment in under 18https://pathways.nice.org.uk/pathways/when-to-suspect-child-maltreatmentOther GuidelinesHypoglycaemia: investigation and management: British Inherited Metabolic Diseases Grouphttp://www.bimdg.org.uk/site/guidelines.aspDiabetic ketoacidosis (DKA): British Society of Endocrinology and Diabeteshttp://www.bsped.org.uk/clinical/clinical_endorsedguidelines.aspxStroke in childhood: Royal College of Paediatrics and Child Healthhttp://www.rcpch.ac.uk/stroke-guidelinePractice standards for young people with substance misuse problems: Royal … ER -