Prediction of Outcome in Pediatric Submersion Injuries Using the PRISM Score

 

Definitions:

(1) drowning: death within 24 hours of the submersion incident

(2) near drowning: survival for >= 24 hours following a submersion incident

(3) warm water incident: submersion in water with temperature > 20°C

(4) cold water incident: submersion in water with temperature <= 20°C

(5) severe neurological impairment includes either (a) conscious but dependent on others for daily support because of impaired neurologic function, or (b) coma, or (c) vegetative state

 

Exclusion criteria used in current study:

(1) pre-existing neurological condition at the time of the submersion incident (head trauma, spinal cord injury, etc.)

(2) cold water submersion incident

(3) use of barbiturates or steroids at the time of initial resuscitation

 

Patients were either admitted to the Emergency Department or directly to the intensive care unit (ICU).

 

The PRISM score (Pollack 1987, 1988) is calculated based on 14 clinical and laboratory variables, as outlined in the chapter on Critical Care.

 

A probability of death can be calculated from the PRISM score for variables on the day of admission, as follows"

 

probability of death =

= EXP(R) / (1 + EXP(R))

 

where:

• R = (0.207 * (PRISM score)) - (0.005 * (age in months)) - 4.782

 

Interpretation

Admission Location	Findings	Outcome
ED	PRISM < 25, OR probability < 50%	survival with intact neurological function
ED	PRISM >= 25, OR probability >= 50%	death or survival with severe neurological impairments
ICU	PRISM <= 5, OR probability < 4%	survival with intact neurological function (low risk population)
ICU	PRISM > 20, OR probability > 50%	death or survival with severe neurological impairments (high risk population)
ICU	(PRISM > 5 AND <= 20), OR (probability >= 4% AND <= 50%)	not accurately predicted (medium risk population)

 

where:

• A discussion on risk populations in the ICU is given on pages 138-139.