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Can children presenting with abnormal mental status just be observed?
The only common situation when a child with AMS can be observed is when they are in the postictal period from a recent seizure.
Otherwise, children presenting with AMS due to trauma, illness, known toxic ingestions, or undefined reasons almost always need laboratory or radiographic studies to be performed.
A recent large study by the Pediatric Emergency Care Applied Research Network (PECARN) identified children at low risk for clinically important traumatic brain injury (ciTBI), but children with GCS scores of 14 or less, or any other signs of AMS, were in the group at high risk of ciTBI, and CT scanning was recommended.
Sources
Kuppermann N, Homes JF, Dayan PS, et al: Identification of children at very low risk of clinically-important brain injuries after head trauma: A prospective cohort study. Lancet 2009;374(9696):1160-1170.
