Prognostic variables in nearly drowned, comatose children
E. Nussbaum
Prognostic variables were evaluated in 51 nearly drowned, comatose
children, and they included values for age, estimated submersion time,
initial arterial pH and core temperature, mean intracranial pressure (ICP),
and mean cerebral perfusion pressure (CPP); the latter two values were
obtained during the first 24 hours. There were 33 survivors (19 with intact
neurologic survival and 14 with brain damage) and 18 deaths. Estimated
submersion time and mean ICP and mean CPP determined survival but could not
predict the neurologic outcome (intact survival or brain damage). Age,
arterial pH, and core temperature were not useful variables in predicting
outcome. This study discourages the use of these unreliable variables in
predicting survival in nearly drowned, comatose victims and, in addition,
cautions against the use of mean ICP, mean CPP, and submersion time as
predictors of neurologic outcome. Since mean ICP and mean CPP measurements
are reliable in predicting survival but not neurologic outcome, major
efforts should be undertaken to explore neurophysiologic and metabolic
prognostic factors that may either discourage or mandate early institution
of aggressive cerebral resuscitative measures in nearly drowned victims.
