Faculty Collaboration Database

Failure of aggressive therapy to alter outcome in pediatric near-drowning. Pediatr Emerg Care 1997 Apr;13(2):98-102

Date

04/01/1997

Pubmed ID

9127416

DOI

10.1097/00006565-199704000-00004

Scopus ID

2-s2.0-0030943372 (requires institutional sign-in at Scopus site)   41 Citations

Abstract

OBJECTIVES: To identify predictors of outcome in pediatric near-drowning victims, and to measure the effectiveness of therapy in pediatric near-drowning victims by assessing clinical outcome as a function of injury severity at presentation and therapeutic interventions during hospitalization.

DESIGN: Retrospective chart review at a tertiary care university associated Children's Hospital from January 1976 to July 1992.

MEASUREMENTS AND MAIN RESULTS: Initial intensive care unit (ICU) assessment included a Glasgow Coma Score (GCS) and a Pediatric Risk of Mortality (PRISM) Score. Outcome was assessed using a standard scoring system classifying functional abilities at hospital discharge as no functional disability, independent, partially independent, or total dependence on caregivers for function. Forty (49%) of 81 died. Of the survivors, 26 (63%) had no functional disability or were partially dependent at hospital discharge. Of the 47 (64%) patients with a GCS < or = 4 on presentation to the ICU, 37 (79%) died and 10 (21%) were dependent in all areas of function at discharge. Of the 40 (60%) patients who had a PRISM score < 20, 98% either died or were completely dependent at discharge. Of the 49 patients who were asystolic upon arrival to the emergency department (ED), 76% died, and the rest were completely dependent. Logistic regression showed that therapy had no independent effect on outcome when disease severity was accounted for.

CONCLUSIONS: Severity of illness measured by GCS and PRISM score in the ICU can be useful in predicting outcome. For patients cared for in a Pediatric Intensive Care Unit, those with asystole on arrival at the ED had uniformly poor outcome. Currently available therapies do not alter outcome.

Author List

Spack L, Gedeit R, Splaingard M, Havens PL

Author

Rainer G. Gedeit MD Associate Chief Medical Officer in the Children's Administration department at Children's Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Female
Forecasting
Hospitals, Pediatric
Humans
Infant
Male
Near Drowning
Retrospective Studies
Severity of Illness Index
Treatment Failure