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.
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).
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.
To read this article in full you will need to make a payment
- Death statistics drowning in Brazil. 1991 (Rio de Janiero)
- Szpilman's classification of near-drowning/drowning: analysis of 2,304 cases in 20 years. 1993 (Presented at the sixth World Congress on Intensive and Critical Care Medicine, Madrid (Spain), June 14–18, and Eighth World Congress on Emergency and Disaster Medicine, Stockholm, Sweden, June 20–23, 1993)
- Resgate e recuperaÇão de 12.038 afogados.J Bras Med. 1972; 9: 50-64
- Cardiovascular physiology in infants and children.in: Motoyana EK Davis PJ Smith's anesthesia for infants and children. 5th ed. Lippincott, 1990: 89-90
- Shock.in: Current medical diagnosis and treatment. Appleton & Lange, East Norwalk Conn1989: 10-11
- Shock.in: Petersdorf RG Adams RD Braunwald E Harrison's principles of internal medicine. 12th ed. McGraw Hill, New York1991: 232-237
- Epi info version 5: a word processing, database, and statistics program for epidemiology on microcomputers. USD, Stone Mountain Ga1990
- Effects of tonicities of saline solutions on pulmonary injury in drowning.Crit Care Med. 1987; 15: 126-130
- The hemodynamic and cardiovascular effects of near-drowning in hypotonic, isotonic, or hypertonic solutions.Ann Emerg Med. 1989; 18: 1044-1049
- Causes of loss of consciousness during underwater swimming.J Appl Physiol. 1961; 15: 583-586
- Submersion in the Netherlands: prognostic indicators and results of resuscitation.Ann Emerg Med. 1990; 19: 1390-1395
- Drowning and near-drowning on Australian beaches patrolled by life-savers: a 10 year study, 1973-1983.Med J Aust. 1988; 148: 165-171
- Clinical course of 91 consecutive near-drowning victims.Chest. 1976; 70: 231-238
- Near-drowning correlation of level of consciousness and survival.Can Anaesth Soc J. 1980; 27: 211-215
- Cerebral salvage in near-drowning following neurological classification by triage.Can Anaesth Soc J. 1980; 27: 201-210
- Intact survival rates in nearly drowning, comatose children.Am J Dis Child. 1986; 140: 504-505
- Childhood near-drowning: is cardiopulmonary resuscitation always indicated?.Crit Care Med. 1989; 17: 993-995
- Prognostic variables in nearly drowned, comatose children.Am J Dis Child. 1986; 140: 329-330
- Fluid administration increases oxygen delivery during continuous positive pressure ventilation after freshwater near-drowning.Crit Care Med. 1983; 11: 693-696
- Drowning [review article].N Engl J Med. 1993; 328: 253-256
- Brady/Prentice Hall, Englewood Cliffs NJ1995: 72-79 The United States lifesaving association manual of open water lifesaving: drowning.
Accepted: March 11, 1997
Received: November 7, 1995
© 1997 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.