Outcome and Predictors of Outcome in Pediatric Submersion Victims Receiving PreHospital Care in King County, Washington

Quan L, Wentz KR, Gore EJ, Copass MK Pediatrics 1990 Pages 586-593

Drowning ranks as the second major cause of death by unintentional injury among children. The predictors of outcome in 10 years of experience (January 1, 1974-December 31, 1983) with pediatric submersion victims treated by Seattle and King Countess pre-hospital emergency services were studied. Of the 205 submersion incidents found, 70 victims did not receive prehospital care from EMS. Of these 70, 2 were transported by private vehicle; the others were considered dead. Of the 135 treated patients less than 20 years of age, most were boys, half were preschool-aged, and half had short submersions (<6 minutes). 45 died and 5 has severe neurologic impairment. A subset of 38 victims found in cardiopulmonary arrest had a 32% survival rate, with 67% of the survivors unimpaired or only mildly impaired. The two risk factors that occurred most commonly in victims who died or were severely impaired were submersion duration greater than 9 minutes (28 patients) and CPR duration longer than 25 minutes (20 patients). Submersion duration was associated with a steadily increasing risk of severe or fatal outcomes: 10% risk (7/67) for 0 to 5 minutes, 56% risk (5/9) for 6 to 9 minutes, 88% risk (21/25) for 10-25 minutes, 100% risk (4/4) for >25 minutes. None of the children receiving >25 minutes of CPR escaped death or severe neurologic impairment. The authors note that the survival rates reported, particularly for victims in cardiopulmonary arrest, are considerably higher than have been reported before for children. Prompt prehospital advanced cardiac life support is the most effective means of medical intervention for the pediatric submersion victim.