Sebastien Julliand1, Marie Desmarest2, Leticia Gonzalez3, Yolanda Ballestero4, Abel Martinez5, Raffaella Moretti6, Aristides Rivas7, Laurence Lacroix8, Armand Biver9, Emilie Lejay2, Lakshmi Kanagarajah10, Nancy Portillo4, Giovanni Crichiutti6, Chiara Stefani11, Liviana Da Dalt11, Daniele Spiri12, Patrick Van De Voorde13, Luigi Titomanlio2. 1. Pediatric Mobile Service for Emergencies and Resuscitation, Robert Debré Hospital, Paris Diderot University, Paris, France. 2. Pediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Paris, France. 3. Pediatric Emergency Department, Rio Hortega Hospital, Valladolid, Spain. 4. Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain. 5. Pediatric Emergency Department, Barcelona University Hospital, Spain. 6. Pediatric Emergency Department, University of Udine, Udine, Italy. 7. Pediatric Emergency Department, Gregorio Marañon General Univerisity Hospital, Madrid, Spain. 8. Pediatric Emergency Department, Geneva University Hospital, Switzerland. 9. Pediatric Emergency Department, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg. 10. Basildon University Hospital, Essex, UK. 11. Pediatric Emergency Department, University of Padova and Treviso Hospital, Italy. 12. Pediatric Emergency Department, Milan University Hospital, Italy. 13. Pediatric Emergency Department, Ghent University Hospital, Ghent, Belgium.
Abstract
BACKGROUND: Loss of consciousness (LOC) is often seen in children. The response of caregivers to a child with LOC has been poorly investigated. Potential caregivers (parents, teachers) seem to have a poor knowledge of the recovery position (RP)-that is, the position into which an unconscious child should be placed in order to protect the airway. OBJECTIVES: To report the management and diagnoses of LOC in childhood, and to evaluate variables associated with an increased hospital admission rate. METHODS: We conducted a prospective cohort study of consecutive children aged between 0 and 18 years diagnosed with LOC at 11 paediatric emergency departments (PEDs) of 6 European countries. The enrolment period was 3 months. Data were obtained from parental interviews, PED reports and clinical examination. RESULTS: 553 children were enrolled. The most frequent final diagnoses causing LOC were seizures (n=278, 50.3%), and vasovagal syncope (n=124, 22.4%). Caregivers put the child in the RP in 145 cases (26.2%). The RP was independently associated with a significant decrease in the admission rate (aOR=0.28; 95% CI 0.17 to 0.48; p<0.0001). CONCLUSIONS: Our study demonstrates for the first time that the RP may reduce the admission rate of infants with LOC. Caregivers often perform inadequate manoeuvres when a child becomes unconscious. Campaigns aiming at increasing knowledge of the RP should be promoted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND:Loss of consciousness (LOC) is often seen in children. The response of caregivers to a child with LOC has been poorly investigated. Potential caregivers (parents, teachers) seem to have a poor knowledge of the recovery position (RP)-that is, the position into which an unconscious child should be placed in order to protect the airway. OBJECTIVES: To report the management and diagnoses of LOC in childhood, and to evaluate variables associated with an increased hospital admission rate. METHODS: We conducted a prospective cohort study of consecutive children aged between 0 and 18 years diagnosed with LOC at 11 paediatric emergency departments (PEDs) of 6 European countries. The enrolment period was 3 months. Data were obtained from parental interviews, PED reports and clinical examination. RESULTS: 553 children were enrolled. The most frequent final diagnoses causing LOC were seizures (n=278, 50.3%), and vasovagal syncope (n=124, 22.4%). Caregivers put the child in the RP in 145 cases (26.2%). The RP was independently associated with a significant decrease in the admission rate (aOR=0.28; 95% CI 0.17 to 0.48; p<0.0001). CONCLUSIONS: Our study demonstrates for the first time that the RP may reduce the admission rate of infants with LOC. Caregivers often perform inadequate manoeuvres when a child becomes unconscious. Campaigns aiming at increasing knowledge of the RP should be promoted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Matthew J Douma; Anthony J Handley; Ella MacKenzie; James Raitt; Aaron Orkin; David Berry; Jason Bendall; Domhnall O'Dochartaigh; Christopher Picard; Jestin N Carlson; Therese Djärv; David A Zideman; Eunice M Singletary Journal: Resusc Plus Date: 2022-04-29