title: Recovery position significantly associated with a reduced admission rate of children with loss of consciousness.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To report the management and diagnoses of LOC in childhood, and to evaluate variables associated with an increased hospital admission rate.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pediatric Mobile Service for Emergencies and Resuscitation, Robert Debré Hospital, Paris Diderot University, Paris, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Julliand
authors.affiliation: Pediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Desmarest
authors.affiliation: Pediatric Emergency Department, Rio Hortega Hospital, Valladolid, Spain.
authors.forename: Leticia
authors.initials: L
authors.lastname: Gonzalez
authors.affiliation: Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Ballestero
authors.affiliation: Pediatric Emergency Department, Barcelona University Hospital, Spain.
authors.forename: Abel
authors.initials: A
authors.lastname: Martinez
authors.affiliation: Pediatric Emergency Department, University of Udine, Udine, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Moretti
authors.affiliation: Pediatric Emergency Department, Gregorio Marañon General Univerisity Hospital, Madrid, Spain.
authors.forename: Aristides
authors.initials: A
authors.lastname: Rivas
authors.affiliation: Pediatric Emergency Department, Geneva University Hospital, Switzerland.
authors.forename: Laurence
authors.initials: L
authors.lastname: Lacroix
authors.affiliation: Pediatric Emergency Department, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg.
authors.forename: Armand
authors.initials: A
authors.lastname: Biver
authors.affiliation: Pediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Paris, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Lejay
authors.affiliation: Basildon University Hospital, Essex, UK.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Kanagarajah
authors.affiliation: Pediatric Emergency Department, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Nancy
authors.initials: N
authors.lastname: Portillo
authors.affiliation: Pediatric Emergency Department, University of Udine, Udine, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Crichiutti
authors.affiliation: Pediatric Emergency Department, University of Padova and Treviso Hospital, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Stefani
authors.affiliation: Pediatric Emergency Department, University of Padova and Treviso Hospital, Italy.
authors.forename: Liviana
authors.initials: L
authors.lastname: Da Dalt
authors.affiliation: Pediatric Emergency Department, Milan University Hospital, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Spiri
authors.affiliation: Pediatric Emergency Department, Ghent University Hospital, Ghent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Van De Voorde
authors.affiliation: Pediatric Emergency Department, Robert Debré Hospital, Paris Diderot University, Paris, France.
authors.forename: Luigi
authors.initials: L
authors.lastname: Titomanlio
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D056888:Patient Positioning / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012640:Seizures / Q000150:complications; D019462:Syncope, Vasovagal / Q000150:complications; D014474:Unconsciousness / Q000209:etiology / Q000628:therapy*
keywords: Accident & Emergency; Comm Child Health