Archivos argentinos de pediatría
versión On-line ISSN 1668-3501
TORRES, Silvio F. et al. Near drowning in a pediatric population: epidemiology and prognosis. Arch. argent. pediatr. [online]. 2009, vol.107, n.3, pp. 234-240. ISSN 1668-3501.
Introduction. Submersion injury is associated with high morbidity and mortality, being the third leading cause of accidental death among children. Objectives. To analyze and describe risk factors, prognosis, and survival of victims, admitted to a third level Community Teaching Hospital. Population, material and methods. A retrospective, observational, analytical study. We studied patients admitted to the pediatric critical care unit, between 06/2000 and 01/2008. The following variables were analyzed: age, sex, length of stay, days of mechanical ventilation, Glasgow Coma Scale (GCS) score, apnea, bradycardia; baseline, 24 and 48 h lactacidemia, submersion time, swimming pool watchers of the victims. Stata 8.0 software was used; continuous variables were analyzed using Wilcoxon test; for categorical variables Z test and Chi square test were used, and a logistic regression analysis was performed. Results. 30 near-drowning victims were admitted, median age was 25 months (R = 11-144 months). 41.3% occurred during summer, 60% were under parental supervision. Sibling supervision was associated with an increased risk of neardrowning (RR: 2.1; 95% CI 1.1-3.2). Immersion time was > 10 minutes in 3.4%; 26% had apnea, and the GCS score was < 5 in 19.99%. Lactic acid at admission was > 3 mmol/l in 10 patients. Risk factors like glucose level ≥ 300 mg% (OR: 3.325), apnea (OR: 2.752), bradycardia (OR: 4.74), GCS <5 (OR: 3.550) and inmersion time > 10 minutes (OR: 5.12), were associated with poor prognosis. Mortality was 2/30 patients. Conclusion. In our population, the presence of apnea, bradycardia, GCS <5, glucose level ≥ 300 mg%, submersion time > 10 minutes, and lactic acid > 6 mmol/l at admission and the first 24 h, were associated with a poor prognosis and serious injury.
Palabras llave : Near drowning; Lactic acid; CPR; Neurologic sequelae.