Korean J Pediatr.  2016 May;59(5):212-217. 10.3345/kjp.2016.59.5.212.

Clinical features and prognostic factors in drowning children: a regional experience

• Son KL
• Hwang SK
• Choi HJ

• KMID: 2164984
• DOI: http://doi.org/10.3345/kjp.2016.59.5.212

Abstract

PURPOSE
This study aimed to evaluate the clinical features of children who have survived a water submersion incident, and to identify risk factors for prognosis.
METHODS
We retrospectively reviewed the medical records of patients who experienced submersion between January 2005 and December 2014. The patients were classified into 2 groups, according to complications, and prognostic factors were evaluated.
RESULTS
During the study period, 29 children experienced submersion (20 boys and 9 girls; mean age, 83.8±46.4 months). Submersion occurred most commonly in the summer, with the peak incidence in August. The most frequent Szpilman clinical score was grade 5 (13 patients; 44.8%), followed by grade 6 (7 patients; 24.1%), and grades 1 or 2 (3 patients; 10.3%). Five children (17.2%) in the poor prognosis group died or had hypoxic ischemic encephalopathy, and the overall mortality rate was 6.9%. Poor prognosis after submersion was associated with lower consciousness levels (P=0.003), higher Szpilman scores (P=0.007), greater need for intubation and mechanical ventilator support (P=0.001), and longer duration of oxygen therapy (P=0.015). Poor prognosis was also associated with lower bicarbonate levels (P=0.038), as well as higher sodium, aspartate transaminase (AST), and alanine transaminase (ALT) levels (P=0.034, P=0.006, and P=0.005, respectively). Szpilman clinical scores were positively correlated with consciousness levels (r=0.489, P=0.002) and serum liver enzyme levels (AST and ALT; r=0.521, P=0.004).
CONCLUSION
We characterized the prognostic factors associated with submersion outcomes, using the Szpilman clinical score, which is comparable to consciousness level for predicting mortality.

Keyword

Drowning; Child; Prognosis

MeSH Terms

Alanine Transaminase
Aspartate Aminotransferases
Child*
Consciousness
Drowning*
Female
Humans
Hypoxia-Ischemia, Brain
Immersion
Incidence
Intubation
Liver
Medical Records
Mortality
Oxygen
Prognosis
Retrospective Studies
Risk Factors
Sodium
Ventilators, Mechanical
Water
Alanine Transaminase
Aspartate Aminotransferases
Oxygen
Sodium
Water