Submersion incidents: a review of 39 cases and development of the submersion outcome score

The optimal treatment of the submersion victim continues to be revised and debated. Accurate analysis of therapeutic response to resuscitation after submersion will require a validated prognostic scale. The patient population is very heterogenous, with few cases presenting at many sites. We selected 11 potential predictive variables to be reviewed in 39 submersion incidents. These included the five variables comprising the Orlowski score. Three ‘physiologic’ variables were identified which, in combination, also predict neurologic outcome: pH less than or equal to 7.10, PaO₂/PAO₂ ratio less than or equal to 0.35, and anion gap greater than or equal to 15 mEq⁻¹. Refinement and validation of a submersion outcome score limited to variables accurately ascertained at presentation will facilitate comparison of treatment protocols.