Clinical features and prognostic factors in drowning children: a regional experience / 소아과

PURPOSE: This study aimed to evaluate the clinical features of children who have survived a water submersion incident, and to identify risk factors for prognosis. METHODS: We retrospectively reviewed the medical records of patients who experienced submersion between January 2005 and December 2014. The patients were classified into 2 groups, according to complications, and prognostic factors were evaluated. RESULTS: During the study period, 29 children experienced submersion (20 boys and 9 girls; mean age, 83.8±46.4 months). Submersion occurred most commonly in the summer, with the peak incidence in August. The most frequent Szpilman clinical score was grade 5 (13 patients; 44.8%), followed by grade 6 (7 patients; 24.1%), and grades 1 or 2 (3 patients; 10.3%). Five children (17.2%) in the poor prognosis group died or had hypoxic ischemic encephalopathy, and the overall mortality rate was 6.9%. Poor prognosis after submersion was associated with lower consciousness levels (P=0.003), higher Szpilman scores (P=0.007), greater need for intubation and mechanical ventilator support (P=0.001), and longer duration of oxygen therapy (P=0.015). Poor prognosis was also associated with lower bicarbonate levels (P=0.038), as well as higher sodium, aspartate transaminase (AST), and alanine transaminase (ALT) levels (P=0.034, P=0.006, and P=0.005, respectively). Szpilman clinical scores were positively correlated with consciousness levels (r=0.489, P=0.002) and serum liver enzyme levels (AST and ALT; r=0.521, P=0.004). CONCLUSION: We characterized the prognostic factors associated with submersion outcomes, using the Szpilman clinical score, which is comparable to consciousness level for predicting mortality.

A Case of Piriform Sinus Fistula Complicated with Suppurative Thyroiditis Treated with Chemocauterization Using Trichloroacetic Acid / 계명의대학술지

A 23 months-old girl visited the hospital because of fever and left neck mass. She was diagnosed as acute suppurative thyroiditis with piriform sinus fistula. Thyroid sonography showed perithyroidal abscess formation and thyroid scan showed decreased uptake of Tc-99m pertechnate of both thyroid glands. Magnetic resonance imaging of neck showed abscess cavity extending to the swollen left thyroid gland. And there was tiny fistula between thyroid and piriform sinus in the barium esophagogram. Streptococcus gordonii was isolated on needle aspiration culture. We report a case of piriform sinus fistula of the neck complicated with suppurative thyroiditis. The fistula was treated with chemocauterization using trichloroacetic acid.