The validity of Glasgow Coma Scale and Rapid Emergency Medicine Score in evaluating patients admitted to the emergency department with drowning or near-drowning

Abstract

Objectives: Deaths and neurological sequels due to the drowning or near-drowning have increased in the recent years. The prediction of these patients’ prognosis is important. The aim of this study is to determine the demographic features of these patients and to evaluate the validity of the scoring systems in predicting the prognosis.
Materials and Methods: This retrospective study was performed in a emergency department (ED) of a university hospital with an annual census of 50000 patients between 2001 and 2007. Patients admitted to the ED with drowning or near-drowning were included into the study. Study patients were determined from the computerized database of the hospital by using International Code of Diseases (ICD-10) (W65-74). The demographic features of the study patients were recorded and the validity of Glasgow Coma Scale (GCS) and Rapid Emergency Medicine Score (REMS) were determined by using Receiving Operating Characteristics (ROC) Curve analysis.
Results: A total of 34 patients were included into the study and 67.6% (23) of them were male. The mean age of the study patients was 31.1±23.2 years (median: 23.5; min-max: 1-88). Twenty eight (82.4%) patients drowned in salt water and six (17.6%) patients in fresh water. Four (11.8%) patients died and all of them drowned in salt water. Only two (5.9%) patients were drunk and one of them died. The Area Under Curve (AUC) values in ROC analysis for GCS and REMS in predicting mortality were 0.875±0.072 (%95 CI: 0.716-0.962) and 0.958±0.071 (95% CI: 0.828-0.995), respectively. However there was no statistically significance between two scoring systems (p=0.083).
Conclusion: Although there are so many scoring systems to be used in patients admitted to ED with drowning or near-drowning, GCS which is the most known scoring system should safely be used.