OUTCOME AND ACUTE-CARE HOSPITAL COSTS AFTER WARM WATER NEAR-DROWNING IN CHILDREN

Objective. Predictive efforts using individual factors or scoring syst ems do not adequately identify all intact survivors, and therefore all drowning victims are aggressively resuscitated in most emergency depa rtments. More reliable outcome prediction is needed to guide early tre atment decisions. Methods. The charts of 274 near drowning patients ad mitted to Loma Linda University Children's Hospital were retrospective ly reviewed. Patient outcome was categorized into good (near normal fu nction), and poor (vegetative or dead) categories. Discriminant analys is was used to identify combinations of variables most able to predict outcome and a clinical classification system was constructed. The acu te care hospital costs for each group were compared. Results. Discrimi nant analysis classification achieved 95% accuracy, predicting death i n 6 intact survivors. No combination of variables could accurately sep arate all intact survivors from the vegetative and dead groups. The cl inical classification method achieved 93% overall accuracy, predicting death in 5 intact survivors. Of patients predicted to have a poor out come, 5 (6.3%) survived intact. Children may experience an unpredictab le, prolonged vegetative state followed by full recovery. Vegetative p atients are the most expensive to care for (consuming 53% of total cos ts) while intact survivors are the least expensive. The majority of co sts were spent on patients with poor outcome. Conclusions. Individual outcome cannot be reliably predicted in the emergency department; ther efore, aggressive resuscitation of near drowning victims should be per formed. Decisions to subsequently withdraw life support should be made based on integration of likelihood of survival, high (but not absolut e) certainty, and parental/societal issues. The vegetative patients ar e the most expensive to care for, while intact survivors are least exp ensive. Reduction of expenditures on patients likely to have vegetativ e or dead outcome would result in substantial savings, but loss of nor mal survivors.