Zeynep Tanyeli, Utku Özer, Şener Çınıçev, Zeliha Akman Üsgüloğlu, Sinem Sarı Gökay
In our study, unlike typical trauma patterns, fatal outcomes in paediatric drowning cases were found to be significantly associated with lower baseline levels of systemic inflammation markers such as SII, NLR, and PLR. This may be related to the extreme acute metabolic and immunologic collapse characteristic of severe drowning cases. We believe that low inflammatory index values should be interpreted as an indicator of a poor prognosis.
OBJECTIVE: Pediatric drowning remains a major global public health crisis, requiring rapid and precise risk stratification upon hospital presentation. While clinical signs are critical, objective biological markers are needed to optimize triage. This study aimed to assess the prognostic value of the Szpilman classification, blood lactate levels, and systemic inflammatory indices, including the systemic immune-inflammation index (SII), neutrophil to lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in predicting mortality among pediatric drowning victims.
MATERIAL AND METHODS: A retrospective analysis was conducted on pediatric patients who presented to a tertiary pediatric emergency department due to drowning between 2020 and 2024. A receiver operating characteristic (ROC) analysis was performed to evaluate the ability of inflammatory indices, the Szpilman classification and blood lactate levels to predict mortality.
RESULTS: A total of 91 pediatric patients (78 nonfatal and 13 fatal) were included in the final analysis. The mean age of the patients was 9.6±5.0 years, with a male predominance (72.5%). All evaluated clinical and laboratory diagnostic models demonstrated high statistical significance in predicting fatal outcomes (P<0.001). On the basis of ROC curve analysis, the calculated prognostic parameters were the Szpilman classification (area under the curve (AUC): 0.978), PLR (AUC: 0.957), lactate levels (AUC: 0.935), SII (AUC: 0.843), and NLR (AUC: 0.817). Crucially, while these indices demonstrated significant predictive capacity, fatal outcomes were explicitly linked to lower baseline values of the PLR, SII, and NLR.
CONCLUSION: In our study, unlike typical trauma patterns, fatal outcomes in paediatric drowning cases were found to be significantly associated with lower baseline levels of systemic inflammation markers such as SII, NLR, and PLR. This may be related to the extreme acute metabolic and immunologic collapse characteristic of severe drowning cases. We believe that low inflammatory index values should be interpreted as an indicator of a poor prognosis.