FAILURE OF AGGRESSIVE THERAPY TO ALTER OUTCOME IN PEDIATRIC NEAR-DROWNING

Objectives: To identify predictors of outcome in pediatric near drowni ng victims, and to measure the effectiveness of therapy in pediatric n ear-drowning victims by assessing clinical outcome as a function of in jury severity at presentation and therapeutic interventions during hos pitalization. Design: Retrospective chart review at a tertiary care un iversity associated Children's Hospital from January 1976 to July 1992 . Measurements and Main Results: Initial intensive care unit (ICU) ass essment included a Glasgow Coma Score (GCS) and a Pediatric Risk of Mo rtality (PRISM) Score, Outcome was assessed using a standard scoring s ystem classifying functional abilities at hospital discharge as no fun ctional disability, independent, partially independent, or total depen dence on caregivers for function, Forty (49%) of 81 died, Of the survi vors, 26 (63%) had no functional disability or were partially dependen t at hospital discharge, Of the 47 (64%) patients with a GCS less than or equal to 4 on presentation to the ICU, 37 (79%) died and 10 (21%) were dependent in all areas of function at discharge, Of the 40 (60%) patients who had a PRISM score <20, 98% either died or were completely dependent at discharge, Of the 49 patients who were asystolic upon ar rival to the emergency department (ED), 76% died, and the rest were co mpletely dependent. Logistic regression showed that therapy had no ind ependent effect on outcome when disease severity was accounted for. Co nclusions: Severity of illness measured by GCS and PRISM store in the ICU can be useful in predicting outcome. For patients cared for in a P ediatric Intensive Care Unit, those with asystole on arrival at the ED had uniformly poor outcome, Currently available therapies do not alte r outcome.