Outcome in children who nearly drown: a British Isles study.

Abstract

OBJECTIVE--To determine the outcome in nearly drowned children in the British Isles and identify factors that might predict a poor prognosis. DESIGN--Study of drowned and of nearly drowned children aged less than or equal to 14. Information on nearly drowned children admitted to hospital obtained from consultant paediatricians returning monthly notification cards through the British Paediatric Surveillance Unit. Information on drowned children obtained from Office of Population Censuses and Surveys and other national epidemiological offices. SETTING--British Isles, 1988 and 1989. SUBJECTS--330 children who had confirmed submersion incidents. 142 died before admission to hospital and 188 children were admitted after nearly drowning. MAIN OUTCOME MEASURES--Death, full recovery, or degree of handicap after near drowning and signs on admission to hospital. RESULTS--All of the children who were conscious on admission fully recovered. Of the 64 children unconscious on admission, 31 had normally reactive pupils and all but three (all of whom had severe preexisting neurological disease) recovered fully. Of the 33 children with fixed dilated pupils on admission, 10 fully recovered, 13 died, and 10 had severe neurological deficit. Spontaneous respiratory effect on admission was associated with normal survival. Pupils that remained dilated six hours after admission and fits continuing 24 hours after admission predicted a poor outcome. CONCLUSION--Children can survive normally after near drowning in the British Isles, particularly if they have been hypothermic. Resuscitation should not be abandoned in nearly drowned children until they have been rewarmed.