Prognostic indicators for near-drowning patients admitted to the pediatric intensive care unit (PICU)

Introduction: Data on prognostic indicators in near-drowning (ND) victims admitted to the PICU is limited. This study evaluates previously described prognostic indicators and the Pediatric Risk of Mortality (PRISM-III) score in ND patients. Methods: Data were analyzed from a cohort of 11,165 consecutive patients admitted to 32 PICUs. Previously identified prognostic indicators and PRISM-III were evaluated in their ability to predict mortality. Results: There were 34 deaths (29%) among 117 ND patients. 39/117 (33%) received CPR and another 18/117 (15%) were intubated without chest compressions prior to PICU admission. Patients needing vasoactive infusions (33/117) had 88% mortality. Of 7 patients (6%) requiring CPR in the PICU, all died. Hypothermic victims (<35°C) in the PICU (28/117) were more likely to die (22/28) compared to non-hypothermic patients (12/89) (OR=23.5, 95% CI 8.1-68.4). Glasgow Coma Score (GCS) was recorded in 78 patients: in all nonsurvivors (n=27), the highest GCS during the first 24 hours after admission was 6. There were no deaths among patients whose lowest GCS was >6 (n=43). Mortality was 85% (23/27) in patients who did not have equal and reactive pupils (OR=7.2, 95% CI 2.1-23.8). Glucose was measured in 89 patients. Mean maximum glucose was higher in non-survivors (313 vs. 156 g/dl, p<0.001). In survivors, none had a maximum glucose > 300 g/dl, whereas 57% of fatalities had a maximum glucose >300 g/dl. PRISM-III scores were calculated at 12 hr: mean (+SD) PRISM-III was 3.2+5.6 hi survivors and 25.1+7.6 in non-survivors (p<0.001). Among non-survivors, no patient had a score <12, whereas 94% of survivors (78/83) had a score <12. Conclusions: No single measure absolutely differentiates survivors from non-survivors in a population of ND victims admitted to the PICU. Patients who died more often had vasoactive infusions, hypothermia, hyperglycemia, GCS<6, and abnormal pupillary reflexes during their first 24 hr of PICU hospitalization. Survivors had 12 hr-PRISM III scores <12.