BACKGROUND Submersion injuries are a leading cause of injury death in children in the United States. The clinical course of a submersion patient varies depending on the presence of anoxic brain injury and acute respiratory failure. OBJECTIVE We studied changes in clinical findings and chest radiograph findings and determined the sensitivity/specificity of the presenting chest radiograph in predicting clinical improvement within the first 24 h in pediatric submersion cases. MATERIALS AND METHODS We conducted a cross-sectional study of pediatric submersion patients through age 18 years treated at a children's hospital from 2010 to 2013. We reviewed demographics, comorbidities, prehospital/hospital course and chest radiographic findings. Clinical improvement occurred when a child demonstrated normal vital signs and mentation. We compared radiographic findings among children based on clinical improvement up to 24 h post submersion. Using odds ratios, we calculated associations between radiographic findings and clinical improvement. We studied the sensitivity/specificity of the presenting chest radiograph in predicting clinical improvement within 24 h. RESULTS One hundred forty-two of 262 (54%) patients had initial chest radiographs; 41% had follow-up radiographs. The odds of an abnormal initial chest radiograph were 4 times higher in children with respiratory distress or abnormal mentation at emergency department (ED) presentation compared to children without these findings (odds ratio [OR]=4.83; 95% confidence interval [CI]=2.1-10.85; P<0.001). Improvement in radiographic findings occurred in 85% of children within 24 h. Children with an abnormal initial chest radiograph were 87% less likely to improve clinically by 24 h (P<0.001). A presenting chest radiograph that was normal or with mild pulmonary edema/atelectasis predicted clinical improvement within 24 h (sensitivity 95%, specificity 57%). CONCLUSION Most chest radiographic findings improve in pediatric submersion patients who recover within the first 24 h. An initial chest radiograph that is normal or with mild pulmonary edema/atelectasis satisfactorily predicts clinical improvement by 24 h post submersion.

中文翻译：

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小儿浸水病例的临床和胸部X光片检查结果的相关性。

背景技术在美国，潜水伤害是儿童死亡的主要原因。浸水患者的临床过程因缺氧性脑损伤和急性呼吸衰竭的存在而异。目的我们研究了临床表现和胸部X光片检查结果的变化，并确定了当前胸部X光片检查在儿童浸入病例头24小时内临床改善的敏感性/特异性。材料与方法我们对2010年至2013年在一家儿童医院接受治疗的18岁以下儿童淹没患者进行了横断面研究。我们回顾了人口统计学，合并症，院前/医院病程和胸部X线影像学表现。当儿童表现出正常的生命体征和精神状态时，临床表现得到改善。我们根据淹没后24 h的临床改善情况比较了儿童的影像学发现。使用比值比，我们计算了影像学发现与临床改善之间的关联。我们研究了目前的胸部X光片在预测24小时内临床改善中的敏感性/特异性。结果262例患者中有142例（54％）进行了首次胸部X片检查。41％的患者接受了放射线照相。与没有这些发现的儿童相比，在急诊科就诊的患有呼吸窘迫或精神错乱的儿童，初始胸部X光片异常的几率要高出4倍（几率[OR] = 4.83； 95％置信区间[CI] = 2.1-10.85； P <0.001）。24小时内85％的儿童的影像学检查结果有所改善。最初胸部X线照片异常的儿童在24小时内临床改善的可能性降低87％（P <0.001）。正常或轻度肺水肿/肺不张的胸部X光片预示24小时内临床好转（敏感性95％，特异性57％）。结论大多数在最初24小时内恢复的儿童浸没患者的胸部X光检查结果会改善。最初的胸部X线片正常或轻度肺水肿/肺不张可令人满意地预测潜水后24小时的临床改善。结论大多数在最初24小时内恢复的儿童浸没患者的胸部X光检查结果会改善。最初的胸部X线片正常或轻度肺水肿/肺不张可令人满意地预测潜水后24小时的临床改善。结论大多数在最初24小时内恢复的儿童浸没患者的胸部X光检查结果会改善。最初的胸部X线片正常或轻度肺水肿/肺不张可令人满意地预测潜水后24小时的临床改善。