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Near-Drowning and Drowning Classification : A Proposal to Stratify Mortality Based on the Analysis of 1,831 Cases FREE TO VIEW

David Szpilman
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From the Fire Department of Rio de Janeiro, Near-Drowning Recuperation Center of Barra da Tijuca, and the Intensive Care Unit, Miguel Couto Municipal Hospital, Rio de Janeiro, Brazil

1997 by the American College of Chest Physicians

Chest. 1997;112(3):660-665. doi:10.1378/chest.112.3.660
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Study objective: To establish an updated classification for near-drowning and drowning (ND/D) according to severity, based on mortality rate of the subgroups.

Materials and methods: We reviewed 41,279 cases of predominantly sea water rescues from the coastal area of Rio de Janeiro City, Brazil, from 1972 to 1991. Of this total, 2,304 cases (5.5%) were referred to the Near-Drowning Recuperation Center, and this group was used as the study database. At the accident site, the following clinical parameters were recorded: presence of breathing, arterial pulse, pulmonary auscultation, and arterial BP. Cases lacking records of clinical parameters were not studied. The ND/D were classified in six subgroups: grade 1—normal pulmonary auscultation with coughing; grade 2—abnormal pulmonary auscultation with rales in some pulmonary fields; grade 3—pulmonary auscultation of acute pulmonary edema without arterial hypotension; grade 4—pulmonary auscultation of acute pulmonary edema with arterial hypotension; grade 5—isolated respiratory arrest; and grade 6—cardiopulmonary arrest.

Results: From 2,304 cases in the database, 1,831 cases presented all clinical parameters recorded and were selected for classification. From these 1,831 cases, 1,189 (65%) were classified as grade 1 (mortality=0%); 338 (18.4%) as grade 2 (mortality=0.6%); 58 (3.2%) as grade 3 (mortality=5.2%); 36 (2%) as grade 4 (mortality=19.4%); 25 (1.4%) as grade 5 (mortality=44%); and 185 (10%) as grade 6 (mortality=93%) (p<0.000001).

Conclusion: The study revealed that it is possible to establish six subgroups based on mortality rate by applying clinical criteria obtained from first-aid observations. These subgroups constitute the basis of a new classification.




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