SERIAL NEUROLOGIC EXAMINATIONS AFTER NEAR-DROWNING AND OUTCOME

Objective: We evaluated serial neurologic examinations after warm wate r near drowning to determine how rapidly survivors with poor neurologi c outcome could be identified. Research Design: Retrospective chart re view. Setting: University-affiliated pediatric hospital. Patients: For ty-four children admitted to the pediatric intensive care unit with an abnormal mental status after near drowning during a 5-year period. Fo llow-up was a minimum of 6 months. Interventions: None. Measurements: A 14-point coma scale was used to evaluate both cortical and brain-ste m function at the time of hospital admission and then daily afterward. The Mann-Whitney U Test was used to compare patients grouped as havin g satisfactory outcomes (those who returned to their presubmersion bas eline or had very mild deficits) and unsatisfactory outcomes (total cu stodial care or death). Significance was defined as P<.05. Conclusion: All satisfactory survivors were sufficiently awake to have spontaneou s, purposeful movements 24 hours after near drowning and had normal br ain-stem function. All children without spontaneous, purposeful moveme nts and normal brain-stem function 24 hours after near drowning suffer ed severe neurologic deficits or death. In this retrospective investig ation of 44 children, the cortical examination 24 hours after warm wat er near drowning distinguished satisfactory survivors from children wh o required total custodial care or died.