Altered level of consciousness emergency management gap: an audit of a tertiary level hospital

Abstract

Rationale, aim and objectives Data on management of altered level of conscious (ALOC) is more consistent for industrialized countries, than in developing countries. The aim was to determine the current practice of pediatric physicians regarding the management of ALOC among children attending the emergency room, Alexandria University Children’s Hospital. Patients and methods This is a descriptive cross-sectional survey. Situational analysis of current practice in the management of children presented with ALOC was done. Data were collected by a self-administered questionnaire designed for the pediatric residents, for medical records of emergency room. Results As regards history taking; the majority of pediatric residents mentioned that they took history related to the underlying disease (97.5%), history of trauma (95%), duration of medications (92.5%), and duration of symptoms (90%). All mentioned that they took history related to vomiting, headache, fever, and family history. The least percentage (55%) was related to the presence of automatism manifestations. Regarding treatment strategy, none of the physicians followed a treatment guideline for initiating treatment. The most frequently recorded items in the reviewed records were present history (100%) and family history (91%). The least recorded items were nutritional history (28%) and history of allergy (30%). Conclusion There is a big variation in practice regarding the management of ALOC in children among resident physicians at Alexandria University Children’s Hospital. Regular audit is required to highlight the management gap and to improve the quality of services offered to the patients. Establishment of a local clinical practice guideline is required to standardize the practice and to narrow the management gap.