Monday, August 15, 2016

Clinical features and prognostic factors in drowning children: a regional experience

Title: Clinical features and prognostic factors in drowning children: a regional experience
Authors: Kyung Lae Son, MD, Su Kyeong Hwang, MD, Hee Joung Choi, MD, PhD
Journal: Korean Journal of Pediatrics, May 2016

This article applies the Szpilman Classification to retrospective drowning data in an attempt to determine prognostic factors.  The Szpilman Classificaiton was derived from research done by Dr David Szpilman in Brazil, and assigns a class (1-6) to drowning patients based on pre-hospital physical exam and vital signs.  In his original study, Dr Spzilman correlated these classes with outcome (the higher the class, the worse the outcome).

Study Summary

  • Study subjects
    • Patients experiencing submersion and admitted to study sites Jan 2005-Dec 2014
    • Total 29 patients (20 boys, 9 girls), all pediatrics
    • Szpilman grades
      • Grade 1-2: 6 patients
      • Grade 3-4: 3 patients
      • Grade 5: 13 patients
      • Grade 6: 7 patients
  • Outcomes
    • Poor neurologic (5 patients)
      • 2 in-hospital deaths (overall mortality 6.9%) 
    • Good neurologic (24 patients)
  • Prognostic factors
    • Age, sex, season, location had no prognostic value
    • Poor outcome
      • lower level of consciousness on arrival
      • higher Szpilman grade
      • All needed intubation and mechanical ventilation
      • Serum bicarbonate lower
      • No pupillary reflex
      • Hypotension
The findings of this study are not surprising. Clinical evidence of prolonged submersion and hypoxia was correlated with worse outcome.  This held true with the finding that a higher Szpilman grade was significantly associated with poor outcome.  The primary weakness of this study is the small study size, but, to my knowledge, it is one of the few if not the first to specifically use to Szpilman score to determine prognosis.