Decreased Conscious Level Multi-site Audit

This multi-site clinical audit, which took place in 2010-11, evaluated some of the recommendations in the guideline, The Management of a Child with a Decreased Conscious Level (2005). The audit aimed to assess whether children with a decreased conscious level are receiving appropriate care according to selected recommendations within the guideline, and to identify how the guideline is implemented in different settings.

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

The guideline was updated in 2015 - see new version.

red-consc-front-cover thumb nail.jpgOn this page:

Reports of audit findings

The reports are now available - see full list


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


  • 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 audit employed three audit tools.

Service description questionnaire - questions about the hospital, the facilities and resources it possesses and the services it offers

Clinical audit questionnaire - anonymised patient information which relate to the audit criteria and standards being measured

Online / postal clinicians' survey - quantitative and qualitative questions that 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 was 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 was collected using an online web tool. 54 NHS trusts (comprising 66 hospitals) were collecting data on the audit.

Data quality

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

Information leaflets

Information leaflets were produced for clinicians and families:

Stakeholders' meeting

On 15 September 2011, we held a stakeholders' meeting to feedback some of the interim project findings and to seek advice on ideas for the  revision of the guideline. PowerPoint presentations and meeting documents:


Clinical Standards Team