Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid (1). To predict prognosis and guide interventions, the Szpilman clinical classification system of six grades is useful (2). In clinical practice, an evaluation by chest X-ray (CXR) and/or thoracic computed tomography (CT) is used along with clinical factors (consciousness, symptoms, vitals, pulmonary auscultation). We hypothesized that the clinical severity would parallel the amount of CT opacities and help to predict prognosis. The purpose of this study was to determine if initial CXR and...

The institutional review board approved this retrospective, cross-sectional study and waived informed patient consent. From December 2001 to December 2012, thoracic CT scans of 34 drowning patients (mean age, 41 years; range, 6-78 years; 21 males, 13 females) were evaluated (Fig 1). A medical record review was performed to evaluate clinical severity and prognosis. To determine the clinical severity, we used the Szpilman’s classification system (Table 1) (2). Clinical severity was assessed by the medical staff (nurse or doctor) on arrival at the hospital. Brain...

Patients characteristics are shown in Table 3. The clinical severity and prognosis are presented in Table 4. The drowning patient groups with long hospitalization (p=0.003), intubation (p<0.0001 or antibiotics (p=0.01) had higher severity score of air-space consolidation on CT. The patient group without intubation had higher severity score of multiple lobular opacities on CT (p=0.01). Non-survivors (p=0.01) and patients with brain anoxia (p=0.03) or long hospitalization (p=0.01) had higher severity score of consolidation on chest X-ray (Table 5). Univariate and multivariate logistic analysis for treatment...

Thoracic CT findings predict treatment in drowning patients. The amount of lung consolidation on thoracic CT is directly associated with need for intubation and antibiotics. Thoracic CT evaluation for drowning can be recommended for Szpilman’s Grade 3 and 4 which are the critical inflection points for treatment decision and prognosis.

1. Szpilman D, Bierens JJLM, Handley AJ, Orlowski JP. Drowning. N Engl J Med. 2012;366:2102–2110. 2. Szpilman D. Near-drowning and drowning classification: A proposal to stratify mortality based on the analysis of 1,831 cases. Chest. The American College of Chest Physicians; 1997;112(3):660–665.