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Childhood near-drowning--factors associated with poor outcome
F O Nagel1, S M Kibel, D W Beatty
1Department of Paediatrics, University of Cape Town.
Insights
Near-drowning patients with neurological signs like fixed pupils or coma, and those needing intensive care like mechanical ventilation, face a higher risk of poor outcomes due to anoxic brain damage.
Area of Science:
- Neurology
- Pediatrics
- Emergency Medicine
Background:
- Anoxic cerebral damage significantly impacts recovery after near-drowning incidents.
- Identifying prognostic factors is crucial for managing near-drowning victims.
Purpose of the Study:
- To identify factors associated with poor outcomes in near-drowned pediatric patients.
- To improve the accuracy of prognosis in the early hours following a near-drowning accident.
Main Methods:
- Retrospective analysis of 100 near-drowned patients' medical records.
- Data collected from the Red Cross War Memorial Children's Hospital between 1976 and 1987.
Main Results:
- Fixed dilated pupils, flaccidity, abnormal posturing (decerebrate/decorticate), and cerebral edema indicate a poor prognosis.
- Metabolic acidaemia and need for cardiopulmonary resuscitation or mechanical ventilation are linked to adverse outcomes.
Conclusions:
- Specific neurological signs and intensive management requirements predict poor outcomes in near-drowning.
- Early identification of these factors allows for more accurate prognostication and tailored patient management.
Abstract:
Anoxic cerebral damage is the limiting factor in recovery from near-drowning accidents. This study reports factors associated with poor outcome in 100 near-drowned patients admitted to the Red Cross War Memorial Children's Hospital from 1976 to 1987. The study was designed as a retrospective folder search. Children with fixed dilated pupils, flaccidity, decerebrate or decorticate posturing, or clinical signs of cerebral oedema are more likely to have a poor outcome. Patients with metabolic acidaemia and those requiring cardiopulmonary resuscitation in the emergency room or subsequent mechanical ventilation also do poorly. Those requiring more aggressive management can be identified and a more accurate working prognosis may be possible in the hours after the accident.