Raess Liliane, Darms Anna, Meyer-Heim Andreas
Swiss Children's Rehab, University Children's Hospital Zurich, 8910 Affoltern a. Albis, Switzerland.
Children (Basel). 2020 Jul 1;7(7):70. doi: 10.3390/children7070070.
Drowning is the second leading cause of unnatural death in childhood worldwide. More than half of the drowned children, who were in need of cardiopulmonary resuscitation (CPR) at the scene suffered from lifelong neurological sequelae. There are few data about prognostic predictors in the pediatric population of drowning victims. The objective of the study was to assess incident characteristics, prognostic parameters, and long-term outcome of children recovering from a drowning incident.
We carried out a retrospective analysis of data of the cohort of pediatric cases (age 0-18) of drowning victims admitted in the years 2000-2015 to the emergency room/intensive care unit/pediatric ward at the University Children's Hospital of Zurich, Switzerland. Outcome was classified by the Pediatric Cerebral Performance Category Scale (PCPCS). New subcategories of severity for known prognostic parameters have been defined. A correlation analysis was performed between the subcategories of the prognostic parameters and the PCPCS.
A total of 80 patients were included in the analysis. Of these, 64% were male, most of the patients were at the age of 0-5 years. More than 80% of the patients were unattended at a public or private pool when the drowning incident happened. In all, 61% ( = 49) needed cardiopulmonary resuscitation (CPR). Of the resuscitated children, 63% showed good to mildly impaired long-term outcome (PCPCS 1-3). Furthermore, 15% ( = 12) were transferred to rehabilitation. Seven children died during the hospital stay and another four died due to complications in the ten years following the incident. The newly defined subcategories of the parameter submersion time, Glasgow Coma Scale (GCS) at time of admission, body temperature at time of admission, blood pH, blood glucose, and blood lactate level correlated significantly with the PCPCS.
Supervision of children, especially boys of the age 0-5 years, next to public or private pools is most important for prevention of drowning incidents in Switzerland. Cardiopulmonary resuscitation done by trained staff leads to a better long-term outcome. Medical decision making in severe cases of drowning should consider submersion time, GCS at time of admission, body temperature at time of admission, blood pH, blood glucose, and blood lactate levels, as these parameters correlate with long-term outcome.
溺水是全球儿童非自然死亡的第二大原因。超过半数在现场需要进行心肺复苏（CPR）的溺水儿童患有终身神经后遗症。关于溺水受害者儿科人群预后预测因素的数据很少。本研究的目的是评估溺水事件康复儿童的事件特征、预后参数和长期结局。
我们对2000年至2015年期间入住瑞士苏黎世大学儿童医院急诊室/重症监护病房/儿科病房的溺水受害者儿科病例队列（年龄0 - 18岁）的数据进行了回顾性分析。结局通过儿科脑功能表现分类量表（PCPCS）进行分类。已定义了已知预后参数的新严重程度亚类。对预后参数亚类与PCPCS之间进行了相关性分析。
共有80例患者纳入分析。其中，64%为男性，大多数患者年龄在0 - 5岁。超过80%的患者在溺水事件发生时在公共或私人泳池无人看管。总体而言，61%（n = 49）需要心肺复苏（CPR）。在接受复苏的儿童中，63%显示出良好至轻度受损的长期结局（PCPCS 1 - 3）。此外，15%（n = 12）被转至康复机构。7名儿童在住院期间死亡，另有4名儿童在事件发生后的十年内因并发症死亡。新定义的淹溺时间、入院时格拉斯哥昏迷量表（GCS）、入院时体温、血液pH值、血糖和血乳酸水平等参数亚类与PCPCS显著相关。
在瑞士，对儿童尤其是0 - 5岁男孩在公共或私人泳池旁进行监管对于预防溺水事件最为重要。由训练有素的工作人员进行心肺复苏可带来更好的长期结局。在严重溺水病例中进行医疗决策时应考虑淹溺时间、入院时GCS、入院时体温、血液pH值、血糖和血乳酸水平，因为这些参数与长期结局相关。
