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Prognostic variables in nearly drowned, comatose children
Insights
Prognostic variables like submersion time, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) predict survival in nearly drowned children but not neurological outcome. Further research into neurophysiologic factors is recommended.
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Emergency Medicine
Background:
- Near-drowning incidents in children often result in coma, necessitating accurate prognostic indicators.
- Predicting survival and neurological outcome in these critically ill children is challenging.
Purpose of the Study:
- To evaluate the predictive value of various clinical and physiological variables for survival and neurological outcome in comatose, near-drowned children.
Main Methods:
- A cohort of 51 comatose, near-drowned children was studied.
- Variables assessed included age, submersion time, arterial pH, core temperature, mean intracranial pressure (ICP), and mean cerebral perfusion pressure (CPP) within the first 24 hours.
Main Results:
- Estimated submersion time, mean ICP, and mean CPP were significant predictors of survival.
- These variables, however, could not reliably predict neurological outcome (intact survival vs. brain damage).
- Age, arterial pH, and core temperature were not useful predictors of outcome.
Conclusions:
- Current prognostic variables like submersion time, ICP, and CPP are unreliable for predicting neurological outcomes in near-drowned children.
- Focus should shift to exploring neurophysiologic and metabolic factors for guiding aggressive cerebral resuscitation strategies.
Abstract:
Prognostic variables were evaluated in 51 nearly drowned, comatose children, and they included values for age, estimated submersion time, initial arterial pH and core temperature, mean intracranial pressure (ICP), and mean cerebral perfusion pressure (CPP); the latter two values were obtained during the first 24 hours. There were 33 survivors (19 with intact neurologic survival and 14 with brain damage) and 18 deaths. Estimated submersion time and mean ICP and mean CPP determined survival but could not predict the neurologic outcome (intact survival or brain damage). Age, arterial pH, and core temperature were not useful variables in predicting outcome. This study discourages the use of these unreliable variables in predicting survival in nearly drowned, comatose victims and, in addition, cautions against the use of mean ICP, mean CPP, and submersion time as predictors of neurologic outcome. Since mean ICP and mean CPP measurements are reliable in predicting survival but not neurologic outcome, major efforts should be undertaken to explore neurophysiologic and metabolic prognostic factors that may either discourage or mandate early institution of aggressive cerebral resuscitative measures in nearly drowned victims.