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Risk Factors Associated With Development of Multiple-Organ Dysfunction Syndrome After Pediatric Drowning
Colton Southard-Goebel1, Francis Pike2, Courtney M Rowan3
1From the Indiana University School of Medicine.
Insights
Pediatric drowning survivors who develop multiple-organ dysfunction syndrome (MODS) face worse outcomes. High blood glucose levels (hyperglycemia) at admission may predict MODS development in these children.
Area of Science:
- Pediatric Intensive Care
- Drowning Medicine
- Critical Care Medicine
Background:
- Pediatric drowning is a leading cause of unintentional injury death.
- Multiple-organ dysfunction syndrome (MODS) is a severe complication following drowning.
- Identifying risk factors for MODS is crucial for improving outcomes.
Purpose of the Study:
- To describe the clinical experience of pediatric drowning at a single center.
- To identify risk factors associated with MODS development after drowning.
- To evaluate the prognostic value of admission parameters for MODS-free survival.
Main Methods:
- Retrospective case-control study of pediatric patients (1 month-25 years) admitted to the PICU after drowning.
- Comparison of patients who developed MODS within 24 hours versus those who did not.
- Multivariable analysis to identify independent risk factors for MODS.
Main Results:
- 48 pediatric drowning patients were analyzed; 60% developed MODS within 24 hours.
- MODS development was associated with increased need for and duration of CPR, and longer submersion times.
- Hyperglycemia (blood glucose > 200 mg/dL) was a significant independent predictor of decreased MODS-free survival at 24 hours.
Conclusions:
- MODS development significantly worsens outcomes in pediatric drowning patients.
- Hyperglycemia is a potentially modifiable risk factor and a useful prognostic marker for MODS in pediatric drowning.
- Early identification of hyperglycemia may guide interventions to improve survival.
Objective:
This study aimed to describe a single-center experience of pediatric drowning and to investigate risk factors associated with the development of pediatric multiple-organ dysfunction syndrome (MODS) after drowning events.
Methods:
A single-center retrospective case-control study was performed at a tertiary children's hospital examining patients aged 1 month to 25 years who were admitted to the pediatric intensive care unit after a drowning event. The study period was June 2016 to June 2021. Patients who developed MODS at day 1 of intensive care admission were compared with those who did not.
Results:
A total of 48 patients with a median age of 2.3 years were included. Twenty-nine (60%) had MODS at 24 hours. Those with MODS at 24 hours were more likely to require cardiopulmonary resuscitation (CPR), required longer duration of CPR, and had longer submersion times; otherwise, there were no differences in baseline characteristics. Those who developed MODS at 24 hours had longer lengths of stays, longer lengths of mechanical ventilation, and higher mortality. Multiple admission parameters were evaluated based on MODS-free survival at 24 hours. On univariable analysis, patients without MODS-free survival at 24 hours had higher rates of CPR, higher blood glucose on admission, higher illness severity scores, higher lactates, and lower Glasgow Coma Scale scores. A multivariable model was constructed using risk factors at presentation that were significant on univariable analysis; blood glucose greater than 200 mg/dL was associated with decreased odds of MODS-free survival at 24 hours after controlling for CPR administration of greater than 5 minutes and body temperature.
Conclusions:
Development of MODS in pediatric drowning is associated with worse patient outcomes. Hyperglycemia was identified as a potentially modifiable risk factor for the development of MODS at 24 hours and could serve as a useful prognostic parameter in this unique patient population.
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