Neuropsychological outcome after severe pediatric near-drowning.

Between April 1979 and August 1983, 49 nearly drowned children in serious condition were admitted to Childrens Hospital of Los Angeles (CHLA) with Glasgow coma scores of 3, 4, or 5 and underwent intracranial pressure monitoring and brain resuscitative therapy. Of the 49 patients, 29 (59%) died in the hospital 1 day to 3 months after admission, 13 (27%) were discharged in vegetative states, and 7 (14%) made good recoveries. No patient made a partial neurological recovery. The sustained mean highest intracranial pressure was significantly higher and the sustained lowest cerebral perfusion pressure was significantly lower for those who died than for survivors (P less than 0.05), but these data did not significantly distinguish between intact and vegetative survivors. Pupillary reactivity noted on arrival at CHLA also significantly discriminated survivors and fatalities (P less than 0.05), but not between intact and vegetative survivors. The presence of any motor activity after arrival at CHLA, even posturing or twitching, indicated a significant chance for intact survival (P less than 0.05), although such activity did not discriminate between death and vegetative survival. Extensive neuropsychological testing indicated that the apparently intact recovered patients generally showed nearly average levels of cognitive functioning, with mild residual gross motor and coordination deficits.