Neurologic long term outcome after drowning in children

Abstract

Drowning is a major source of mortality and morbidity in children worldwide. Neurocognitive outcome of children after drowning incidents cannot be accurately predicted in the early course of treatment. Therefore, aggressive out-of-hospital and in-hospital treatment is emphasized. There are "miracle" cases after long submersion times that have been reported in the medical literature, which mostly concern small children. However, many of the survivors will remain severely neurologically compromised after remarkably shorter submersion times and will consequently be a great burden to their family and society for the rest of their lives. The duration of submersion, the need of advanced life support at the site of the accident, the duration of cardiopulmonary resuscitation, whether spontaneous breathing and circulation are present on arrival at the emergency room are important factors related to survival with mild neurological deficits or intact function in drowned children. Data on long-term outcome are scarce. The used outcome measurement methods and the duration of follow-up have not been optimal in most of the existing studies. Proper neurological and neurophysiological examinations for drowned children are superior to outcome scales based chart reviews. There is evidence that gross neurological examination at the time of discharge from the hospital in young children does not reveal all the possible sequelae related to hypoxic brain injury and thus long-term follow-up of drowned resuscitated children is strongly recommended.

Patterns of multiorgan dysfunction after pediatric drowning

“…Detailed neuropsychological outcome testing was not performed which would be particularly important to assess in the RA patients where favorable outcome was achieved. Recent literature by Suominen and colleagues 36 suggests that discharge examination is not a reliable indicator of the pediatric drowning victim neurologic outcome and there is a need for proper neurological and neurophysiological assessments to determine the severity of the neurologic insult. In addition, the study of MODS in the pediatric population is the lack of use of a uniform scoring system in all published studies, thus making data interpretation and comparisons challenging.…”

Drowning in children: Utstein style reporting and outcome

“…Hypoxic brain injury is the major cause of morbidity after drowning incidents . In our study, neurologic sequelae after hospital discharge were evident in just one patient receiving only bystander CPR.…”

“…The neurological status of the survivors of the present study was evaluated retrospectively from the hospital records against the POPC scale at discharge from the hospital and after a 1‐year follow‐up period, as it is currently recommended by the Utstein guidelines . However, proper neurological and neurophysiological examinations for drowned children would have been superior to retrospective chart reviews . Drowned children may indeed function at a level consistent with age expectations at discharge from the hospital.…”

Drowning and Emergency Department

“…On beş yaş altı çocuklarda ise ikinci sırada kaza ile ölüm sebebidir. [10] Çalışmamızda 41olgunun dördünde ölüm gözlenmiştir ve tüm ölümler 15 yaş altındadır. Boğul-malarda yaş dağılımlarının ve yaşa göre mortalite oranlarının tanımlanması boğulmayı önleyecek tedbirlerin alınması açı-sından önemlidir.…”