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Musculoskeletal consequences of near-drowning in children
1Group Health Cooperative of Puget Sound, Tacoma, Washington.
Insights
Children who nearly drown and experience cardiac arrest or altered neurological status often develop anoxic encephalopathy or die. Musculoskeletal issues like spasticity and hip dislocations are common, impacting long-term mobility.
Area of Science:
- Pediatric Neurology
- Neurology
- Pediatric Critical Care
Background:
- Near-drowning incidents in children can lead to severe neurological impairment.
- Anoxic encephalopathy is a significant risk following submersion injuries.
Purpose of the Study:
- To investigate the neurological and musculoskeletal outcomes in children who nearly drowned.
- To identify predictors of ambulation and functional status in survivors.
Main Methods:
- Retrospective analysis of pediatric patients with near-drowning injuries.
- Assessment of neurological status, including anoxic encephalopathy.
- Evaluation of musculoskeletal complications and functional outcomes.
Main Results:
- 30% developed anoxic encephalopathy, 36% died, and 34% recovered neurologically.
- Common musculoskeletal issues included contractures (34%), hip subluxation/dislocation (34%), and scoliosis (18%).
- Only 31% achieved ambulation; independent sitting predicted ambulation potential.
Conclusions:
- Near-drowning survivors face high risks of neurological deficits and long-term musculoskeletal problems.
- Early functional assessment is crucial for predicting long-term mobility in these children.
- Comprehensive management is needed to address the complex sequelae of near-drowning injuries.
Abstract:
Nearly drowned children sustaining cardiac or respiratory arrest or altered neurologic status developed anoxic encephalopathy (30%), died in the ensuing days (36%), or were discharged neurologically normal (34%). In encephalopathic children, spasticity was more malignant than in children with other causes of spasticity. The most common musculoskeletal problem was contracture, especially equinus, hip adductor, hamstring, and quadriceps. Hip subluxation or dislocation occurred in 34% as early as 1 month after injury. Scoliosis developed in 18%, with some requiring bracing and surgery. Thirty-one percent ambulated, and the rest were quadriplegic. Independent sitting or better function by discharge was a predictor of ambulation potential. Of the quadriplegics, 66% were dependent sitters.