Evaluation of assessment instruments used on children presenting with altered level of consciousness.

OBJECTIVE: To compare current care with a proposed gold standard (formal coma scale use) for assessment of children presenting with altered consciousness. DESIGN: A prospective study. SETTING: Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS: One hundred and seventy children consecutively admitted to the hospital. MAIN OUTCOME MEASURES: Proportion of children assessed using a formal coma scale (gold standard) while presenting with altered consciousness. RESULTS: Findings revealed that only 8% of children were assessed using the formal coma scale at admission. The level of neurological deficit was described using general and potentially misleading descriptive terms rather than formal coma scales. CONCLUSION: The use of a formal coma scale and relevant simple investigations were seldom used. The quality of care of children admitted to the hospital with altered consciousness standard would benefit from defining and implementing management guidelines (protocols).