Related Experiment Video
Updated: Jun 23, 2026
SECONDs Administration Guidelines: A Fast Tool to Assess Consciousness in Brain-injured Patients
Published on: February 6, 2021
Evaluation of assessment instruments used on children presenting with altered level of consciousness
P W Njuguna1, D P Oyatsi, M English
1Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya.
Insights
Formal coma scales are rarely used for assessing children with altered consciousness in Kenyan hospitals. Implementing standardized protocols and investigations is crucial for improving care quality.
Area of Science:
- Pediatric Neurology
- Clinical Assessment
- Healthcare Quality Improvement
Background:
- Altered consciousness in children requires accurate neurological assessment.
- Current assessment practices may lack standardization, potentially impacting care quality.
- Formal coma scales offer a standardized method for evaluating neurological deficits.
Purpose of the Study:
- To compare existing methods of assessing children with altered consciousness against a proposed gold standard.
- To evaluate the utilization of formal coma scales in a pediatric setting.
Main Methods:
- A prospective study was conducted at Kenyatta National Hospital in Nairobi, Kenya.
- One hundred and seventy children admitted with altered consciousness were consecutively enrolled.
- The primary outcome measure was the proportion of children assessed using a formal coma scale upon admission.
Main Results:
- Only 8% of admitted children with altered consciousness were assessed using a formal coma scale.
- Neurological deficits were frequently described using non-standardized, potentially misleading terms.
- Formal coma scales were seldom employed in clinical practice.
Conclusions:
- The study highlights a significant gap in the use of standardized neurological assessment tools for pediatric patients.
- Implementing formal coma scales and evidence-based management guidelines is recommended to enhance the quality of care.
- There is a need for defined protocols to improve the management of children with altered 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).
