SERIAL NEUROLOGIC EXAMINATIONS AFTER NEAR-DROWNING AND OUTCOME

Objective: We evaluated serial neurologic examinations after warm water near drowning to determine how rapidly survivors with poor neurologic outcome could be identified. Research Design: Retrospective chart review. Setting: University-affiliated pediatric hospital. Patients: Forty-four children admitted to the pediatric intensive care unit with an abnormal mental status after near drowning during a 5-year period. Follow-up was a minimum of 6 months. Interventions: None. Measurements: A 14-point coma scale was used to evaluate both cortical and brain-stem function at the time of hospital admission and then daily afterward. The Mann-Whitney U Test was used to compare patients grouped as having satisfactory outcomes (those who returned to their presubmersion baseline or had very mild deficits) and unsatisfactory outcomes (total custodial care or death). Significance was defined as P<.05. Conclusion: All satisfactory survivors were sufficiently awake to have spontaneous, purposeful movements 24 hours after near drowning and had normal brain-stem function. All children without spontaneous, purposeful movements and normal brain-stem function 24 hours after near drowning suffered severe neurologic deficits or death. In this retrospective investigation of 44 children, the cortical examination 24 hours after warm water near drowning distinguished satisfactory survivors from children who required total custodial care or died.