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Pediatr Radiol. 2020 Jan 2. doi: 10.1007/s00247-019-04588-x. [Epub ahead of print]

Correlation of clinical and chest radiograph findings in pediatric submersion cases.

Author information

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.

KEYWORDS:

Children; Clinical course; Drowning; Lungs; Radiography; Submersion injury

PMID:
31897567
DOI:
10.1007/s00247-019-04588-x

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