Pediatric Near Drowning: The Experience of King Khalid University Hospital

Abstract

The purpose of the study was to evaluate the outcome of warm pediatric near drowning, and assess possible predictors of the outcome. The study was performed at King Khalid University Hospital, Riyadh, Saudi Arabia. Twenty-eight cases of pediatric near drowning (one to 13 years of age) over a 10-year period ending June 1998, were reviewed retrospectively. Multiple variables during the prehospital and the hospital stages were evaluated to assess their effect on the outcome. None of the patients' families had official training in cardiopulmonary resuscitation. Only one of the 21 private swimming pools had features compatible with swimming pool safety regulations. Eleven patients (39.3%) died in the pediatric intensive care, and 17 (60.7%) were discharged alive. Submersion time of >5 minutes and the emergency room documentation of absence of vital signs, Glasgow Coma Scale of < or =4, arterial pH of < or =7.0 and blood sugar of > or =10 mmol/L all predicted bad outcome, with a statistical significance (P< 0.05). This audit highlighted major concerns about our prehospital medical care, general population basic life support education and our society's adherence to swimming pool safety regulations. It demonstrated that hypothermia on arrival to the emergency department in warm near-drowning victims is likely to be associated with bad outcome. The audit results also agree with the opinion of not aggressively intervening or prolonging aggressive intervention in warm near-drowning cases presenting with bad prognostic outcome.