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Related Experiment Videos

Predicting outcome in pediatric submersion victims

W D Graf1, P Cummings, L Quan

  • 1Department of Pediatrics, Children's Hospital and Medical Center, University of Washington School of Medicine, USA.

Annals of Emergency Medicine
|September 1, 1995
PubMed
Summary

Predicting outcomes for children after near-drowning is possible using four key factors: coma, absent pupillary light reflex, sex, and initial blood glucose. This helps identify children at high risk for unfavorable outcomes.

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Area of Science:

  • Pediatric Emergency Medicine
  • Neuroscience
  • Toxicology

Background:

  • Near-drowning incidents in children are a significant cause of pediatric morbidity and mortality.
  • Accurate prediction of outcomes is crucial for guiding clinical management and parental counseling.
  • Existing prediction models may lack specificity or sensitivity in diverse pediatric populations.

Purpose of the Study:

  • To develop and validate a prediction rule for determining outcomes in children following near-drowning events.
  • To identify key clinical and demographic variables associated with unfavorable outcomes (death or vegetative state).
  • To establish a practical tool for risk stratification in pediatric submersion victims.

Main Methods:

  • Retrospective cohort study including 194 children admitted after non-icy water submersion.

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  • Variables evaluated included demographic, episode-related, clinical, laboratory, and treatment data at admission.
  • A prediction rule was developed using partitioning and logistic regression, combining variables to predict outcome.

    • Main Results:

    • The prediction rule achieved 100% specificity, correctly identifying all children with favorable outcomes.
    • Among comatose children, unfavorable outcomes were predicted by absent pupillary light reflex, elevated initial blood glucose, and male sex.
    • The rule had a sensitivity of 65%, indicating it was overly optimistic for 35% of patients with unfavorable outcomes.

    Conclusions:

    • A four-variable prediction rule (coma, absent pupillary light reflex, sex, initial blood glucose) can stratify pediatric near-drowning victims into high or low likelihoods of unfavorable outcomes.
    • This rule demonstrates high specificity, ensuring accurate prediction of favorable outcomes.
    • Further validation in an independent cohort is recommended to confirm the rule's utility.