Brandon J Ho1, James E Crowe2, Scott R Dorfman2, Elizabeth A Camp3, Shabana Yusuf3, Rohit P Shenoi4. 1. Department of Pediatrics, Children's National Medical Center, Washington, DC, USA. 2. Department of Radiology, Texas Children's Hospital, Houston, TX, USA. 3. Department of Pediatrics, Baylor College of Medicine, 6621 Fannin St., Suite A 2210, Houston, TX, 77030, USA. 4. Department of Pediatrics, Baylor College of Medicine, 6621 Fannin St., Suite A 2210, Houston, TX, 77030, USA. rshenoi@bcm.edu.
Abstract
BACKGROUND: Submersion injuries are a leading cause of injury death in children in the United States. The clinical course of a submersion patient varies depending on the presence of anoxic brain injury and acute respiratory failure. OBJECTIVE: We studied changes in clinical findings and chest radiograph findings and determined the sensitivity/specificity of the presenting chest radiograph in predicting clinical improvement within the first 24 h in pediatric submersion cases. MATERIALS AND METHODS: We conducted a cross-sectional study of pediatric submersion patients through age 18 years treated at a children's hospital from 2010 to 2013. We reviewed demographics, comorbidities, prehospital/hospital course and chest radiographic findings. Clinical improvement occurred when a child demonstrated normal vital signs and mentation. We compared radiographic findings among children based on clinical improvement up to 24 h post submersion. Using odds ratios, we calculated associations between radiographic findings and clinical improvement. We studied the sensitivity/specificity of the presenting chest radiograph in predicting clinical improvement within 24 h. RESULTS: One hundred forty-two of 262 (54%) patients had initial chest radiographs; 41% had follow-up radiographs. The odds of an abnormal initial chest radiograph were 4 times higher in children with respiratory distress or abnormal mentation at emergency department (ED) presentation compared to children without these findings (odds ratio [OR]=4.83; 95% confidence interval [CI]=2.1-10.85; P<0.001). Improvement in radiographic findings occurred in 85% of children within 24 h. Children with an abnormal initial chest radiograph were 87% less likely to improve clinically by 24 h (P<0.001). A presenting chest radiograph that was normal or with mild pulmonary edema/atelectasis predicted clinical improvement within 24 h (sensitivity 95%, specificity 57%). CONCLUSION: Most chest radiographic findings improve in pediatric submersion patients who recover within the first 24 h. An initial chest radiograph that is normal or with mild pulmonary edema/atelectasis satisfactorily predicts clinical improvement by 24 h post submersion.
BACKGROUND: Submersion injuries are a leading cause of injury death in children in the United States. The clinical course of a submersion patient varies depending on the presence of anoxic brain injury and acute respiratory failure. OBJECTIVE: We studied changes in clinical findings and chest radiograph findings and determined the sensitivity/specificity of the presenting chest radiograph in predicting clinical improvement within the first 24 h in pediatric submersion cases. MATERIALS AND METHODS: We conducted a cross-sectional study of pediatric submersion patients through age 18 years treated at a children's hospital from 2010 to 2013. We reviewed demographics, comorbidities, prehospital/hospital course and chest radiographic findings. Clinical improvement occurred when a child demonstrated normal vital signs and mentation. We compared radiographic findings among children based on clinical improvement up to 24 h post submersion. Using odds ratios, we calculated associations between radiographic findings and clinical improvement. We studied the sensitivity/specificity of the presenting chest radiograph in predicting clinical improvement within 24 h. RESULTS: One hundred forty-two of 262 (54%) patients had initial chest radiographs; 41% had follow-up radiographs. The odds of an abnormal initial chest radiograph were 4 times higher in children with respiratory distress or abnormal mentation at emergency department (ED) presentation compared to children without these findings (odds ratio [OR]=4.83; 95% confidence interval [CI]=2.1-10.85; P<0.001). Improvement in radiographic findings occurred in 85% of children within 24 h. Children with an abnormal initial chest radiograph were 87% less likely to improve clinically by 24 h (P<0.001). A presenting chest radiograph that was normal or with mild pulmonary edema/atelectasis predicted clinical improvement within 24 h (sensitivity 95%, specificity 57%). CONCLUSION: Most chest radiographic findings improve in pediatric submersion patients who recover within the first 24 h. An initial chest radiograph that is normal or with mild pulmonary edema/atelectasis satisfactorily predicts clinical improvement by 24 h post submersion.
Authors: T Gluecker; P Capasso; P Schnyder; F Gudinchet; M D Schaller; J P Revelly; R Chiolero; P Vock; S Wicky Journal: Radiographics Date: 1999 Nov-Dec Impact factor: 5.333
Authors: Anriada Nassif; Daniel G Ostermayer; Kim B Hoang; Mary K Claiborne; Elizabeth A Camp; Manish I Shah Journal: Prehosp Emerg Care Date: 2018-01-19 Impact factor: 3.077