Near-drowning: correlation of level of consciousness and survival

This paper reports a retrospective review of 121 cases of near-drowning treated at university hospitals in Miami and Gainesville. The series included 57 adults and 64 children who were classified into three categories, Category A (Awake), Category B (Blunted) and Category C (Comatose), based on their level of consciousness on arrival at the primary hospital. Results based on the total 121 patients showed 87 per cent survived with apparently normal brain function, two per cent survived with impaired brain function and 11 per cent died. The survival rate of all patients who were awake when they entered the hospital was significantly greater than that of both those who were admitted and blunted consciousness (p = 0.05) and those who were comatose when admitted (p less then 0.0001). Further, the group whose members had blunted consciousness had a significantly greater number of normal survivors than the group whose members were comatose on admission (p less than 0.002). All treated adults survived without permanent neurological damage and only three surviving children in the series suffered residual brain damage. Whether the course of the seven patients, three adults and four children, who died without return of brain function, would have been altered by deliberate attempts to preserve the brain is a matter of speculation.