Quan L, Wentz K R, Gore E J, Copass M K
Department of Pediatrics, University of Washington School of Medicine, Seattle.
Pediatrics. 1990 Oct;86(4):586-93.
Predictors of outcome in pediatric submersion victims treated by Seattle and King County's prehospital emergency services were studied. Victims less than 20 years old were identified from hospital admissions and paramedic and medical examiners' reports. The proportion of fatal or severe outcomes in patients were compared with various risk factors. Of 135 patients, 45 died and 5 had severe neurologic impairment. A subset of 38 victims found in cardiopulmonary arrest had a 32% survival rate, with 67% of 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 cardiopulmonary resuscitation duration longer than 25 minutes (20 patients). Both factors were ascertained in the prehospital phase of care. 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 to 25 minutes, 100% risk (4/4) for greater than 25 minutes. None of 20 children receiving greater than 25 minutes of cardiopulmonary resuscitation escaped death or severe neurologic impairment. Our rates for saving all victims, particularly victims in cardiopulmonary arrest, are considerably higher than has been reported before the children. Prompt prehospital advanced cardiac life support is the most effective means of medical intervention for the pediatric submersion victim. Prehospital information provided the most valuable predictors of outcome.
对西雅图和金县院前急救服务所治疗的小儿溺水受害者的预后预测因素进行了研究。通过医院入院记录、护理人员和法医报告确定年龄小于20岁的受害者。将患者中致命或严重后果的比例与各种风险因素进行比较。在135名患者中，45人死亡，5人有严重神经功能障碍。在38名心脏骤停的受害者中，生存率为32%，67%的幸存者未受损伤或仅轻度受损。在死亡或严重受损的受害者中最常见的两个风险因素是溺水持续时间超过9分钟（28例患者）和心肺复苏持续时间超过25分钟（20例患者）。这两个因素均在院前护理阶段确定。溺水持续时间与严重或致命后果的风险稳步增加相关：0至5分钟时风险为10%（7/67），6至9分钟时风险为56%（5/9），10至25分钟时风险为88%（21/25），超过25分钟时风险为100%（4/4）。20名接受超过25分钟心肺复苏的儿童无一逃脱死亡或严重神经功能障碍。我们拯救所有受害者，尤其是心脏骤停受害者的成功率，比以前报道的儿童成功率要高得多。及时的院前高级心脏生命支持是小儿溺水受害者最有效的医疗干预手段。院前信息提供了最有价值的预后预测因素。
