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Clinical Investigations: Water SportsNear-Drowning and Drowning Classification: A Proposal to Stratify Mortality Based on the Analysis of 1,831 Cases
Section snippets
Area and Population Researched
We retrospectively reviewed 41,279 cases of predominantly sea water rescues, utilizing rescue bulletins recorded by lifeguards on the beaches, from January 1972 to December 1991. These cases were observed in a restricted sample area of 22 km that falls under the authority of the Rio de Janeiro rescue service, and that constitutes 23% of the total coastal area of Rio de Janeiro City. From this population, 2,304 cases (5.5%) were referred to the NDRC during the study period because they had been
Population Surveyed
From 2,304 cases of ND/D referred to the NDRC because they required medical assistance, 92.6% (2,134 cases) were rescued from water by lifeguards and 7.4% (170 cases) were rescued by bathers present at the accident site (including all fresh water cases). All cases attended on the beach by an ambulance with the medical team had an average response time of 12.3±5.8 min. Of those sea water ND/D patients (2,274 cases), 90% were brought by ambulance and the rest (10%) were taken to the NDRC by
Discussion
The idea of updating the classification we previously used derived from the observation of cases in which some clinical parameters—acute pulmonary edema with hypotension and apnea without cardiac arrest—seemed to stratify into subgroups with different mortality rates. These observations were the impetus for a retrospective survey that demonstrated the validity of analyzing each clinical parameter, dividing cases of ND/D into six different grades of severity according to an initial examination.
Conclusion
A new ND/D classification is suggested, taking into consideration 20 years of NDRC activity, accumulating a total of 1,831 cases for which four clinical parameters (breathing, pulse, pulmonary auscultation, and BP) were reported. These parameters were statistically significant in defining the classification of six different grades (p<0.00001). If this classification becomes universally accepted, multicenter studies to evaluate the several therapies proposed in the literature,20 but still
Acknowledgments
The authors wish to acknowledge the generous assistance of the staffs of the Miguel Couto Municipal Hospital and the Fire Department of Rio de Janeiro NDRC, especially my colleagues Adilson Ramos de Amoedo, Newton Tomás, Maria Luisa Toscano, Henrique Wolfgang Besser, Otavio Sena Paris, Roberto Bassan, David Chapman, Ian Mackie, James P. Orlowski, as well as The Brazilian Life Saving Society (SOBRASA).
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