Abstract

Despite advances in medical treatment and technology, outcome following pediatric drowning can vary widely from mild to severe impairments and death. Prognosis is often difficult to predict given a number of contributing factors. As such, this study examined the relationship between clinical indicators including submersion duration, initial GCS and PRISM scores, and waking time with outcome as well as metabolite ratios based on magnetic resonance spectroscopy. Research stemming from the area of cardiac arrest as well as anecdotal case study reports of cold water drownings suggests that lowering the body temperature may be helpful and protective. As such, the use of therapeutic hypothermia to reduce injurious effects following a drowning event was examined.

Ten children who experienced a drowning accident participated in this study with 50% treated under normothermic conditions and 50% treated with therapeutic hypothermia. Participants were screened prior to or soon after discharge and also received a developmental evaluation 6 months following the drowning accident. This study found that although clinical indicators did not significantly correlate with outcomes, trends were observed for estimated submersion times, CPR duration, and PRISM scores. With respect to MRS metabolite ratios, lowered levels of NAA/Cho, NAA/Cre, and elevated Cho/Cre were associated with negative outcomes such as death and vegetative status. The presence of lactate was the strongest predictor and accurately predicted non-vegetative verses vegetative/dead outcome for all participants. Results indicated that therapeutic hypothermia may be helpful in treating young children who experience a drowning accident. Treatment with therapeutic hypothermia was more strongly associated with non-vegetative outcomes, whereas participants who were treated under normothermic conditions were more likely to have vegetative/dead outcomes. However, more research is needed to evaluate the effectiveness of therapeutic hypothermia as confounding variables could not be ruled out. Lastly, participants who were assessed 6 months following the drowning accident showed no signs of impairments in their developmental functioning.

LLU Discipline

Clinical Psychology

Department

Clinical Psychology

School

School of Science and Technology

First Advisor

Kim Freeman

Second Advisor

Shamel Abd-allah

Third Advisor

Todd Burley

Fourth Advisor

Theodore Wu

Fifth Advisor

Ludmila Zaytsev

Degree Name

Doctor of Philosophy (PhD)

Degree Level

Ph.D.

Year Degree Awarded

2009

Date (Title Page)

9-2009

Language

English

Library of Congress/MESH Subject Headings

Drowning -- Child; Near Drowning -- therapy; Emergency Treatment -- Child; Hypothermia -- metabolism; Hypothermia, Induced -- methods; Unconsciousness -- physiopathology; Cardiopulmonary Resuscitation -- methods; Recovery of Function; Time Factors; Age Factors; Brain Injuries -- physiopathology; Brain Ischemia -- therapy; Neurobehavioral Manifestations -- in infancy & childhood; Clinical Trials; Neuropsychological Tests; Magnetic Resonance Spectroscopy -- methods; Survival Analysis; Outcome and Process Assessment (Health Care)

Type

Dissertation

Page Count

xiii; 119

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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