Page created on February 8, 2022. Last updated on December 18, 2024 at 16:58
Differential diagnosis
Unconsciousness can be due to one of these three mechanisms:
- Bilateral hemispherical disorder
- Brainstem dysfunction
- Systemic metabolic disorder
| Etiology | Typical features |
| CNS infection (meningitis, encephalitis) | Abrupt onset, warm child, tachycardia, meningeal signs |
| Diabetic ketoacidosis | Fruity odour, known diabetes, slow onset |
| Hypoglycaemia | Known diabetes, slow onset |
| Inborn error of metabolism | Slow onset, hepatomegaly, jaundice |
| Trauma | Bruising |
| Intoxication (drugs, heavy metal, chemical) | Unattended child |
| Intracranial pathology (haemorrhage, infarct) | Neurological asymmetry on examination, abnormal pupil, preceding headache and vomiting, papilloedema |
| Hypo/hyperthermia | Child temperature |
| Drowning | Wet child, cold child |
| Seizures | Abrupt onset |
Glasgow coma scale in children
| GCS in older children | GCS in children < 4 years | Score | |
| Eye opening |
Spontaneous |
4 | |
|
To sound |
3 | ||
| To pressure | To pain | 2 | |
|
None |
1 | ||
| Best verbal response | Oriented | Talks normally, interacts | 5 |
| Confused | Words | 4 | |
| Words | Vocal sounds | 3 | |
| Sounds | Cries | 2 | |
| None | None | 1 | |
| Best motor response |
Obeys commands |
6 | |
| Localising | Localises pain | 5 | |
| Normal flexion | Flexion to pain | 4 | |
|
Abnormal flexion (decorticate posture) |
3 | ||
|
Abnormal extension (decerebrate posture) |
2 | ||
|
No response |
1 | ||
GCS 8 or lower is an indication for intubation.
Treatment
For management, see topic A6.