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Pediatric submersions: prehospital predictors of outcome
Insights
Prehospital factors like submersion and resuscitation duration, sinus rhythm, and pupil response accurately predict outcomes for pediatric drowning victims. Aggressive emergency medical services can improve survival rates in these cases.
Area of Science:
- Pediatric Emergency Medicine
- Drowning and Resuscitation Science
- Clinical Epidemiology
Background:
- Pediatric submersion injuries present significant challenges in prehospital care.
- Identifying reliable prognostic indicators in the field is crucial for guiding resuscitation efforts and resource allocation.
Purpose of the Study:
- To evaluate prehospital prognostic indicators for pediatric victims of non-icy water submersion.
- To correlate field assessments with patient outcomes at hospital discharge.
Main Methods:
- Retrospective cohort study of pediatric submersion victims (age < 20) treated by emergency medical services in King County, WA (1985-1989).
- Data sourced from emergency medical services logs, hospital records, and medical examiner registries.
- Correlation of field prognostic factors with hospital discharge condition.
Main Results:
- Seventy-seven pediatric victims were identified; 29 experienced cardiac arrest with 13 achieving return of spontaneous circulation.
- Survival rate was 21% (6/29), with varying degrees of neurologic impairment.
- Key predictors for poor outcome included submersion > 10 minutes and resuscitation > 25 minutes.
- Predictors for good outcome included sinus rhythm, reactive pupils, and neurologic responsiveness at the scene.
Conclusions:
- Field-determined prognostic factors are reliable predictors of outcome in pediatric drowning victims.
- Aggressive prehospital resuscitation is beneficial for victims with short submersion times.
- Consideration should be given to pronouncing pediatric drowning victims dead in the field if advanced life support yields no response within 25 minutes.
Abstract:
This retrospective cohort study was conducted to test prehospital prognostic indicators in pediatric submersion victims. The authors studied all less than 20 years old victims submerged in the non-icy waters of King County, WA who were treated by Seattle or King County Emergency Medical Services between 1985 and 1989 and were hospitalized or died. Seventy-seven victims were identified from emergency medical services incident logs, hospital discharge records, and medical examiner's registries. Outcome predictors were correlated with the victim's condition at hospital discharge. Of 29 victims in cardiac arrest, 13 had return of spontaneous circulation following field resuscitation. Of these, 6 (21%) survived, with mild (n = 2) and severe (n = 4) neurologic impairment at hospital discharge. The best outcome predictors were obtained in the field. These were, for death or severe neurologic impairment, submersion durations > 10 minutes (6/6) and resuscitation durations > 25 minutes (17/17), and for good outcome, sinus rhythm (37/37), reactive pupils (43/43), and neurologic responsiveness (40/40) at the scene. Field-determined factors were reproducibly good outcome predictors. Aggressive emergency medical services may save the lives of pediatric victims in cardiac arrest following short submersion durations. The data support pronouncing dead in the field those pediatric victims of non-icy submersions who do not respond to advanced life support within 25 minutes.