Cranial computed tomographic findings in a large group of children with drowning: Diagnostic, prognostic, and forensic implications*

Rafaat, Karim T.; Spear, Robert M.; Kuelbs, Cynthia L.; Parsapour, Kourosh; Peterson, Bradley M.

doi:10.1097/pcc.0b013e31818c8955

Cited by 53 publications

(40 citation statements)

References 23 publications

(23 reference statements)

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“…One patient with basilar cistern effacement had a favorable neurologic outcome. Quantitative loss of GWM differentiation measured in HUr was significantly associated with mortality and unfavorable neurologic outcome: death (0.96; HUr, 0.88, 1.07) versus survival (1.14; HUr, 1.1, 1.2) ( p < 0.001) and unfavorable (1.03; HUr, 0.92, 11) versus favorable (1.16; HUr, 1.11, 1.2) ( p < 0.001). Using a cutpoint of 1.2 HUr, the sensitivity of qualitative loss of GWM differentiation for survival was 27% and the specificity was 92%.…”

Section: Resultsmentioning

confidence: 97%

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Early Head CT Findings Are Associated With Outcomes After Pediatric Out-of-Hospital Cardiac Arrest*

Starling¹,

Shekdar²,

Licht

et al. 2015

Pediatric Critical Care Medicine

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Objectives Head CT after out-of-hospital cardiac arrest is often obtained to evaluate intracranial pathology. Among children admitted to the PICU following pediatric out-of-hospital cardiac arrest, we hypothesized that loss of gray-white matter differentiation and basilar cistern and sulcal effacement are associated with mortality and unfavorable neurologic outcome. Design Retrospective, cohort study. Setting Single, tertiary-care center PICU. Patients Seventy-eight patients less than 18 years old who survived out-of-hospital cardiac arrest to PICU admission and had a head CT within 24 hours of return of spontaneous circulation were evaluated from July 2005 through May 2012. Interventions None. Measurements and Main Results Median time to head CT from return of spontaneous circulation was 3.3 hours (1.0, 6.0). Median patient age was 2.3 years (0.4, 9.5). Thirty-nine patients (50%) survived, of whom 29 (74%) had favorable neurologic outcome. Nonsurvivors were more likely than survivors to have 1) loss of gray-white matter differentiation (Hounsfield unit ratios, 0.96 [0.88, 1.07] vs 1.1 [1.07, 1.2]; p < 0.001), 2) basilar cistern effacement (93% vs 7%; p = 0.001; positive predictive value, 94%; negative predictive value, 59%), and 3) sulcal effacement (100% vs 0%; p ≤ 0.001; positive predictive value, 100%; negative predictive value, 68%). All patients with poor gray-white matter differentiation or sulcal effacement had unfavorable neurologic outcomes. Only one patient with basilar cistern effacement had favorable outcome. Conclusions Loss of gray-white matter differentiation and basilar cistern effacement and sulcal effacement are associated with poor outcome after pediatric out-of-hospital cardiac arrest. Select patients may have favorable outcomes despite these findings.

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Section: Resultsmentioning

confidence: 97%

“…Early CT loss of gray-white matter (GWM) differentiation is associated with worse survival and neurologic outcomes following adult OHCA (8–10). One study of children who suffered drowning, with a small subset having had a cardiac arrest, also demonstrated an association of loss of GWM with worse outcome (11). …”

mentioning

confidence: 99%

Early Head CT Findings Are Associated With Outcomes After Pediatric Out-of-Hospital Cardiac Arrest*

Starling¹,

Shekdar²,

Licht

et al. 2015

Pediatric Critical Care Medicine

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“…In reality, however, when cases of known death from hypoxia in infants and children have been reported, subdural hemorrhages were not present [20][21][22]. Many infants who experience episodes of confirmed hypoxia are imaged to determine the extent of brain damage.…”

Section: Introductionmentioning

confidence: 95%

Alternate theories of causation in abusive head trauma: What the science tells us

Jenny

2014

Pediatr Radiol

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“…A study of paediatric drowning found that all patients with an abnormal initial brain CT died, the most common abnormality being loss of greyewhite differentiation. 12 The main clinical features associated with death or poor neurological outcome are listed in Box 3.…”

Section: Prognosismentioning

confidence: 99%

Drowning and immersion injury

Hooper¹,

Hockings²

2011

Anaesthesia & Intensive Care Medicine

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Drowning is a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium. The victim may live or die after this process, but whatever the outcome, he or she has been involved in a drowning incident'. There are no specific interventions that have been proven to improve outcomes in drowning victims and thus prevention of drowning is the priority. Underlying medical conditions (whether previously diagnosed or not) must be considered as potentially having contributed to the drowning incident e and may have implications for both the victim and their relatives. Pathophysiological events in the process of drowning are secondary to hypoxaemia that results from the submersion/immersion insult. The major determinant of outcome after drowning is the degree of neurological insult and subsequent recovery. Management priorities in the drowning victim revolve around restoration of oxygenation, circulation and thermoregulation. Compression-only cardiopulmonary resuscitation is not recommended in drowning victims. Hypothermia is common and may limit the efficacy of resuscitative attempts when severe. Therapeutic hypothermia can be considered in the treatment of unconscious survivors of drowning. Patients who are unconscious on admission to hospital have a guarded prognosis.

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Cranial computed tomographic findings in a large group of children with drowning: Diagnostic, prognostic, and forensic implications*

Cited by 53 publications

References 23 publications

Early Head CT Findings Are Associated With Outcomes After Pediatric Out-of-Hospital Cardiac Arrest*

Early Head CT Findings Are Associated With Outcomes After Pediatric Out-of-Hospital Cardiac Arrest*

Alternate theories of causation in abusive head trauma: What the science tells us

Drowning and immersion injury

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