Wednesday, September 26, 2012

Neurologic long term outcome after drowning in children

As with any disease process, the burden of a drowning incident does not stop after the acute event has been managed.  With the primary pathophysiology being hypoxic/anoxic brain injury, the long term effects and prognosis following a drowning incident can vary greatly from individual to individual based on the severity of the initial injury.  Decades of research have gone into determining prognostic indicators associated with drowning, especially in the pediatric population.

Recently, the Scandanavian Journal of Trauma published an article entitled Neurologic long term outcome after drowning in children (Suominen P, Vähätalo R).  This article reports on the findings from a review of literature to determine the following:

  1. the main factors related to the outcomes of drowned children
  2. existing evidence of long-term neurologic outcome.
Through this review, important factors which have been shown to affect survival were reported as follows: the duration of submersion, the need of advanced life support at the site of the accident, the duration of CPR, and the establishment of spontaneous breathing and circulation on arrival to the ER.  As would be expected, most of these factors can be directly related to the level of hypoxic injury experienced by the patient.

The authors also presented the findings from a series of articles which report on long-term neurologic sequelae following drowning incidents.  There was unfortunately a very large amount of variability on the quality of data and the data points available for analysis.  One data point which was affected greatly was reported submersion time, which highlights the importance of standard reporting of drowning incidents and high quality pre-hospital data collection.