Decreased Conscious Level Multi-site Audit

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In 2005, the Paediatric Accident and Emergency Research Group in Nottingham published an evidence-based guideline, Management of a Child (aged 0-18 years) with a Decreased Conscious Level for the management of children presenting with a decreased conscious level with the aim of improving and standardising the assessment, investigations and treatment.

This 18-month multi-site clinical audit is funded by the National Reyes Syndrome Foundation UK and coordinated by the Royal College of Paediatrics and Child Health. The project's Clinical Lead is Dr Stephanie Smith, Consultant Paediatrician in Emergency Medicine at Nottingham University Hospital.

The final report of the audit's findings is now available!


A decreased conscious level may be the result of a number of different conditions, ranging from traumatic injury, infections to metabolic illnesses. The annual hospital admission rate for head injuries is 381 children per 100,000, while the incidence of non-traumatic coma is 30 children per 100,000 per year. In some cases it can prove to be fatal. It is therefore essential that the appropriate assessments and investigations are carried out to help establish the cause quickly so that potentially life-saving treatment can be initiated without delay.

Timeframe for the audit

The period of data collection for this audit was 1 November 2010 to 30 September 2011.

Aims of the audit

The aims of this multi-site audit are as follows:

  • to assess whether children with a decreased conscious level are receiving appropriate care, in line with the decreased conscious level guideline, by means of a multi-site clinical audit providing meaningful comparative data to individual service providers
  • to identify how the guideline is currently being implemented in different settings, and identify any barriers to change
  • to use the findings to inform the development of a quality improvement programme, which has the potential to improve the care of children with a decreased conscious level nationally
  • to use the results to inform the development of a sustainable and cost-effective guideline implementation programme which can be adapted and rolled out for other College endorsed guidelines.

Audit tools

The decreased conscious level multi-site audit employs three audit tools:

  1. Service Description Questionnaire: This comprises questions about the hospital, the facilities and resources it possesses and the services it offers.
  2. Clinical Audit Questionnaire: This consists of anonymised patient information which relate to the audit criteria and standards being measured.
  3. Online/Postal Clinicians' Survey: This consists of quantitative and qualitative questions which examine clinicians' use and perceptions of the Management of a Child with a Decreased Conscious Level guideline and potential facilitators and barriers for compliance with the guideline recommendations.

Data collection and participating NHS trusts

Data is collected prospectively (during the course of the audit) on eligible cases of children or young people presenting to hospital with a decreased conscious level. Data for the service description and clinical audit questionnaires is collected using an online web tool.

54 NHS trusts (comprising 66 hospitals) are collecting data on the audit (see participating NHS trusts).

Data quality

Data will undergo systematic checking, cleaning and quality assurance for missing, inconsistent or erroneous data items during the course of the audit. Missing and invalid data will be highlighted to the units by means of a hospital specific data quality report and a data quality newsletter.

Data quality newsletters

Information leaflets

Information leaflets are available about the Decreased Conscious Level multi-site audit for both clinicians and families.  If you would like to receive a paper-version of these leaflets, please contact the DeCon Project Team.

DeCon Newsletters

The DeCon newsletters provides snapshot information on the audit's findings.

September Stakeholders' meeting

On 15 September 2011, the DeCon Project Team held a stakeholders' meeting to feedback some of the interim project findings and to seek advice on ideas for the  revision of the Management of a Child with a Decreased Conscious Level guideline. The powerpoint presentations and meeting documents for this day are available below:

Project update

(Last updated  20 February 2012)

  • The DeCon Multi-site Audit has now been completed.
  • 54 NHS trusts comprising 66 hospitals participated in the audit.
  • There were 1135 cases submitted from 51/54 trusts.
  • The final report containing the audit's results, the clinicians' survey and the recommendations for improved care of children and young people presenting to hospital with a decreased conscious level is now available.

Contact us for more information

Clinical Standards: