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Predicting outcome in pediatric near-drowning
Ratanotai Plubrukarn1, Siriluck Tamsamran
1Pediatric Department, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand.
Insights
Early identification of near-drowning outcomes in children is challenging. While some clinical factors predict good outcomes, aggressive early treatment and monitoring are crucial for all near-drowning victims.
Area of Science:
- Pediatric Emergency Medicine
- Drowning Victim Outcomes
- Clinical Prediction Models
Background:
- Near-drowning incidents are a significant cause of child mortality and long-term disability.
- Survivors may remain in a vegetative state, posing a substantial burden on families and society.
Purpose of the Study:
- To determine if outcomes for pediatric near-drowning can be reliably predicted early in the illness course.
- To identify key clinical variables for predicting outcomes in near-drowning survivors.
Main Methods:
- Retrospective study of 72 pediatric near-drowning cases from 1993-2001.
- Utilized stepwise multivariate discriminant analysis to identify predictive variables.
- Evaluated combinations of emergency department (ED) physical exam, cardiopulmonary resuscitation (CPR) needs, adrenaline dosage, and blood glucose levels.
Main Results:
- A combination of ED exam, CPR need, adrenaline amount, and high blood sugar accurately predicted outcomes (83% overall).
- Predicting good vs. poor outcomes (vegetative/dead) achieved 98% accuracy.
- Glasgow Coma Scale score ≥ 5, CPR need in ED, and blood sugar > 300 mg/dL predicted outcomes with 96% accuracy, though with a 6% error in predicting good outcomes for those with poor prognoses.
Conclusions:
- Accurate differentiation between intact survivors and vegetative states is not consistently achievable early on.
- Simple clinical classifications can identify potential good outcomes.
- Due to prediction limitations, all near-drowning victims require aggressive early treatment and close monitoring for complications.
Background:
Near-drowning is common in children and has a high mortality rate. Some survivors remain in a vegetative state after the accident and are a great burden to their family and society.
Objectives:
To find out whether outcomes on near drowning can be reliably identified early in the course of illness.
Method:
Medical records of 72 children admitted to Queen Sirikit National Institute of Child Health, Bangkok, Thailand, for treatment of near drowning from January 1993 to December 2001 were retrospectively studied. Stepwise multivariate discriminant analysis was used to identify the power of variables achieving highest overall accuracy in minimizing errors for predicting poor outcome in intact survivors.
Results:
The patients were identified into three groups: functionally intact, vegetative and dead groups, it was found that a combination of physical examination in the emergency department (ED), the need for cardiopulmonary (CPR) in the ED, amount of adrenaline given during CPR, and high blood sugar achieved an overall accuracy of 83 per cent. When categorizing patients into good outcome versus poor outcome (the combination of the vegetative and dead group were the poor outcome group). The variables mentioned above achieved an overall accuracy of 98 per cent. Good outcome survivors could be correctly predicted with no error, but error occurred when poor outcome survivors were predicted to be good outcome in 3 per cent. Glasgow coma score > or = 5, the need for CPR in the ED and blood sugar > 300 mg/dl were selected clinical variables found to have optimum predictive abilities with an overall accuracy of 96 per cent, but showed an error of 6 per cent in predicting poor outcome from functional intact survivors (unpredicted good outcome).
Conclusion:
From the present study discrimination analysis cannot accurately separate all intact survivors from the vegetative groups, but can prospectively differentiate unpredicted good outcome from vegetative or dead groups. When using only simple clinical classification systems, unpredicted good outcome patients are detected. Since outcome cannot be accurately predicted in the ED, all near drowning victims should receive vigorous and aggressive treatment in the early course of illness and need close monitoring for respiratory complications and neurological signs.
