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June 1986

Intact Survival Rates in Nearly Drowned, Comatose Children

Author Affiliations

Division of Neurosurgery Childrens Hospital of Los Angeles PO Box 54700 Los Angeles, CA 90054-0700

Am J Dis Child. 1986;140(6):504. doi:10.1001/archpedi.1986.02140200014005

Sir.—The article on "Prognostic Variables in Nearly Drowned, Comatose Children" by Nussbaum1 indicated a 37% (19/51) neurologically intact survival rate in nearly drowned children who on initial examination were reported to be flaccid, did not respond to pain, and had fixed dilated pupils, absence of spontaneous respiration, hypotension, and poor perfusion. In a recent study that my colleagues and I have just published,2 our survival rate was only 14% (7/49). Why was there such a significant difference in apparent intact survival rates? Forty-eight of the 49 patients in our series were seen at an outside emergency room and were subsequently transferred to Childrens Hospital of Los Angeles (CHLA). Although complete information was not available, virtually all of the patients were reported not to have any significant motor activity at the time of the initial emergency room admission. When these patients were reexamined at CHLA after an interval

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