Julliand Sebastien, Desmarest Marie, Gonzalez Leticia, Ballestero Yolanda, Martinez Abel, Moretti Raffaella, Rivas Aristides, Lacroix Laurence, Biver Armand, Lejay Emilie, Kanagarajah Lakshmi, Portillo Nancy, Crichiutti Giovanni, Stefani Chiara, Da Dalt Liviana, Spiri Daniele, Van De Voorde Patrick, Titomanlio Luigi
Pediatric Mobile Service for Emergencies and Resuscitation, Robert Debré Hospital, Paris Diderot University, Paris, France.
Pediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Paris, France.
Arch Dis Child. 2016 Jun;101(6):521-526. doi: 10.1136/archdischild-2015-308857. Epub 2016 Jan 25.
Loss of consciousness (LOC) is often seen in children. The response of caregivers to a child with LOC has been poorly investigated. Potential caregivers (parents, teachers) seem to have a poor knowledge of the recovery position (RP)-that is, the position into which an unconscious child should be placed in order to protect the airway.
To report the management and diagnoses of LOC in childhood, and to evaluate variables associated with an increased hospital admission rate.
We conducted a prospective cohort study of consecutive children aged between 0 and 18 years diagnosed with LOC at 11 paediatric emergency departments (PEDs) of 6 European countries. The enrolment period was 3 months. Data were obtained from parental interviews, PED reports and clinical examination.
553 children were enrolled. The most frequent final diagnoses causing LOC were seizures (n=278, 50.3%), and vasovagal syncope (n=124, 22.4%). Caregivers put the child in the RP in 145 cases (26.2%). The RP was independently associated with a significant decrease in the admission rate (aOR=0.28; 95% CI 0.17 to 0.48; p<0.0001).
Our study demonstrates for the first time that the RP may reduce the admission rate of infants with LOC. Caregivers often perform inadequate manoeuvres when a child becomes unconscious. Campaigns aiming at increasing knowledge of the RP should be promoted.
意识丧失（LOC）在儿童中很常见。照顾者对意识丧失儿童的反应尚未得到充分研究。潜在的照顾者（父母、教师）似乎对恢复体位（RP）了解不足，即应将失去意识的儿童放置的体位，以保护气道。
报告儿童意识丧失的管理和诊断情况，并评估与住院率增加相关的变量。
我们在6个欧洲国家的11个儿科急诊科（PEDs）对连续诊断为意识丧失的0至18岁儿童进行了一项前瞻性队列研究。入组期为3个月。数据通过家长访谈、PED报告和临床检查获得。
共纳入553名儿童。导致意识丧失最常见的最终诊断是癫痫发作（n = 278，50.3%）和血管迷走性晕厥（n = 124，22.4%）。145例（26.2%）照顾者将儿童置于恢复体位。恢复体位与住院率显著降低独立相关（调整后比值比 = 0.28；95%置信区间0.17至0.48；p < 0.0001）。
我们的研究首次表明，恢复体位可能会降低意识丧失婴儿的住院率。当儿童失去意识时，照顾者的操作往往不充分。应开展旨在提高对恢复体位认识的宣传活动。
