Bratton S L, Jardine D S, Morray J P
Department of Anesthesiology, University of Washington, School of Medicine, Seattle.
Arch Pediatr Adolesc Med. 1994 Feb;148(2):167-70. doi: 10.1001/archpedi.1994.02170020053008.
We evaluated serial neurologic examinations after warm water near drowning to determine how rapidly survivors with poor neurologic outcome could be identified.
Retrospective chart review.
University-affiliated pediatric hospital.
Forty-four children admitted to the pediatric intensive care unit with an abnormal mental status after near drowning during a 5-year period. Follow-up was a minimum of 6 months.
None.
A 14-point coma scale was used to evaluate both cortical and brain-stem function at the time of hospital admission and then daily afterward. The Mann-Whitney U Test was used to compare patients grouped as having satisfactory outcomes (those who returned to their presubmersion baseline or had very mild deficits) and unsatisfactory outcomes (total custodial care or death). Significance was defined as P < .05.
All satisfactory survivors were sufficiently awake to have spontaneous, purposeful movements 24 hours after near drowning and had normal brain-stem function. All children without spontaneous, purposeful movements and normal brain-stem function 24 hours after near drowning suffered severe neurologic deficits or death. In this retrospective investigation of 44 children, the cortical examination 24 hours after warm water near drowning distinguished satisfactory survivors from children who required total custodial care or died.
我们评估了温水溺水后连续的神经系统检查，以确定能多快识别出神经系统预后不良的幸存者。
回顾性病历审查。
大学附属医院儿科。
5年间44名因溺水后精神状态异常入住儿科重症监护病房的儿童。随访至少6个月。
无。
入院时及之后每日使用14分昏迷量表评估皮质和脑干功能。采用曼-惠特尼U检验比较结局良好组（恢复到溺水前基线或有非常轻微缺陷者）和结局不良组（完全监护或死亡）的患者。显著性定义为P <.05。
所有结局良好的幸存者在溺水后24小时都足够清醒，能有自发的、有目的的运动，且脑干功能正常。所有在溺水后24小时无自发、有目的运动且脑干功能不正常的儿童都有严重的神经功能缺损或死亡。在这项对44名儿童的回顾性研究中，温水溺水后24小时的皮质检查可区分结局良好的幸存者与需要完全监护或死亡的儿童。
