{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T07:24:49Z","timestamp":1787297089718,"version":"build-2736575974"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      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\u00b15.0 years, with a male predominance (72.5%). All evaluated clinical and laboratory diagnostic models demonstrated high statistical significance in predicting fatal outcomes (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000003676","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T07:00:12Z","timestamp":1787295612000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Value of the Szpilman Classification, Blood Lactate Levels, and Systemic Inflammatory Indices in Pediatric Drowning Patients"],"prefix":"10.1097","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9586-0262","authenticated-orcid":false,"given":"Zeynep","family":"Tanyeli","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Adana City Training and Research Hospital, Pediatric Emergency Medicine Clinic, Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utku","family":"\u00d6zer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Adana City Training and Research Hospital, Pediatric Emergency Medicine Clinic, Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u015eener","family":"\u00c7\u0131n\u0131\u00e7ev","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Adana City Training and Research Hospital, Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeliha","family":"Akman \u00dcsg\u00fclo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Adana City Training and Research Hospital, Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinem","family":"Sar\u0131 G\u00f6kay","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Adana City Training and Research Hospital, Pediatric Emergency Medicine Clinic, Adana, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"R1-20260821","doi-asserted-by":"crossref","first-page":"e501","DOI":"10.1161\/CIR.0000000000001274","article-title":"2024 American Heart Association and American Academy of Pediatrics Focused Update on Special Circumstances: Resuscitation Following Drowning: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"150","author":"Dezfulian","year":"2024","journal-title":"Circulation"},{"key":"R2-20260821","doi-asserted-by":"crossref","first-page":"e339","DOI":"10.3928\/19382359-20250916-02","article-title":"Pediatric drowning: a preventable cause of morbidity and mortality","volume":"54","author":"Harries","year":"2025","journal-title":"Pediatr Ann"},{"key":"R3-20260821","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/j.emc.2024.02.014","article-title":"Drowning","volume":"42","author":"Davis","year":"2024","journal-title":"Emerg Med Clin North Am"},{"key":"R4-20260821","doi-asserted-by":"crossref","first-page":"1553","DOI":"10.1186\/s12889-020-09650-0","article-title":"Social and environmental risk factors for the accidental drowning of children under five in China","volume":"20","author":"Wang","year":"2020","journal-title":"BMC Public Health"},{"key":"R5-20260821","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/PEC.0000000000003382","article-title":"Prehospital and resuscitation factors associated with favorable pediatric drowning outcomes","volume":"41","author":"Shenoi","year":"2025","journal-title":"Pediatr Emerg Care"},{"key":"R6-20260821","doi-asserted-by":"crossref","first-page":"156","DOI":"10.15441\/ceem.24.240","article-title":"Predictors of good prognosis for pediatric drowning patients","volume":"12","author":"Cho","year":"2025","journal-title":"Clin Exp Emerg Med"},{"issue":"suppl_2","key":"R7-20260821","first-page":"S578","article-title":"Part 10: Adult and pediatric special circumstances of resuscitation: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"152","author":"Cao","year":"2025","journal-title":"Circulation"},{"key":"R8-20260821","doi-asserted-by":"crossref","first-page":"162184","DOI":"10.1016\/j.jpedsurg.2025.162184","article-title":"Beneath the surface: a retrospective analysis of pediatric drowning trends & risk factors in Quebec","volume":"60","author":"Dimmer","year":"2025","journal-title":"J Pediatr Surg"},{"key":"R9-20260821","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12874-025-02483-8","article-title":"The Danish drowning cohort: utstein-style data from fatal and non-fatal drowning incidents in Denmark","volume":"25","author":"Breindahl","year":"2025","journal-title":"BMC Med Res Methodol"},{"key":"R10-20260821","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1186\/1757-7241-20-55","article-title":"Neurologic long term outcome after drowning in children","volume":"20","author":"Suominen","year":"2012","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"R11-20260821","doi-asserted-by":"crossref","first-page":"2102","DOI":"10.1056\/NEJMra1013317","article-title":"Drowning","volume":"366","author":"Szpilman","year":"2012","journal-title":"N Engl J Med"},{"key":"R12-20260821","doi-asserted-by":"crossref","first-page":"121","DOI":"10.5835\/jecm.omu.29.02.008","article-title":"Retrospective review of patients who presented to the emergency department with drowning injuries.","volume":"29","author":"Ba\u015fol","year":"2012","journal-title":"J Exp Clin Med"},{"key":"R13-20260821","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1378\/chest.112.3.660","article-title":"Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1,831 cases","volume":"112","author":"Szpilman","year":"1997","journal-title":"Chest"},{"key":"R14-20260821","doi-asserted-by":"crossref","first-page":"2445","DOI":"10.2147\/IJGM.S450585","article-title":"Correlation between NLR combined with PLR score and prognosis of hepatocellular carcinoma after liver transplantation","volume":"17","author":"Niu","year":"2024","journal-title":"Int J Gen Med"},{"key":"R15-20260821","doi-asserted-by":"crossref","first-page":"03000605241270696","DOI":"10.1177\/03000605241270696","article-title":"Assessment of neutrophil to lymphocyte ratio, platelet to lymphocyte ratio and systemic immune-inflammatory index, as diagnostic markers for neonatal sepsis","volume":"52","author":"Zhu","year":"2024","journal-title":"J Int Med Res"},{"key":"R16-20260821","first-page":"702","article-title":"The neutrophil-to-lymphocyte ratio: a narrative review","volume":"10","author":"Faria","year":"2016","journal-title":"Ecancermedicalscience"},{"key":"R17-20260821","doi-asserted-by":"crossref","DOI":"10.3389\/fsurg.2022.917172","article-title":"The neutrophil-to-lymphocyte ratio: a potential predictor of poor prognosis in adult patients with trauma and traumatic brain injury","volume":"9","author":"Xu","year":"2022","journal-title":"Front Surg"},{"key":"R18-20260821","doi-asserted-by":"crossref","first-page":"3758068","DOI":"10.1155\/2018\/3758068","article-title":"Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically ill and injured patients: which ratio to choose to predict outcome and nature of bacteremia?","volume":"2018","author":"Djordjevic","year":"2018","journal-title":"Mediators Inflamm"},{"key":"R19-20260821","doi-asserted-by":"crossref","first-page":"R12","DOI":"10.1186\/cc11157","article-title":"Failure to normalize lymphopenia following trauma is associated with increased mortality, independent of the leukocytosis pattern","volume":"16","author":"Heffernan","year":"2012","journal-title":"Crit Care"},{"key":"R20-20260821","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.3390\/jcm12031128","article-title":"Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and risk of all-cause mortality and cardiovascular mortality: a 20-year follow-up cohort study of 42,875 US adults","volume":"12","author":"Xia","year":"2023","journal-title":"J Clin Med"},{"key":"R21-20260821","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jemermed.2018.10.033","article-title":"Early lactate dynamics in critically ill non-traumatic patients in a resuscitation room of a German Emergency Department (OBSERvE-Lactate-Study)","volume":"56","author":"Kramer","year":"2019","journal-title":"J Emerg Med"},{"key":"R22-20260821","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1164\/rccm.201710-2006OC","article-title":"Early immune function and duration of organ dysfunction in critically ill children with sepsis","volume":"198","author":"Muszynski","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"R23-20260821","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1097\/00003246-199607000-00010","article-title":"Sir Isaac Newton, sepsis, SIRS, and CARS","volume":"24","author":"Bone","year":"1996","journal-title":"Crit Care Med"},{"key":"R24-20260821","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/S1473-3099(13)70001-X","article-title":"Immunosuppression in sepsis: a novel understanding of the disorder and a new therapeutic approach","volume":"13","author":"Hotchkiss","year":"2013","journal-title":"Lancet Infect Dis"},{"key":"R25-20260821","doi-asserted-by":"crossref","first-page":"208","DOI":"10.4103\/tjem.tjem_248_24","article-title":"Predicting mortality and safe discharge in drowning victims: A comprehensive analysis of neurological and clinical outcomes in the emergency department","volume":"25","author":"Kara","year":"2025","journal-title":"Turk J Emerg Med"},{"key":"R26-20260821","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4274\/eajem.galenos.2018.94830","article-title":"Comparison of trauma scoring systems in pediatric trauma patients","volume":"18","author":"Sultano\u011flu","year":"2019","journal-title":"Eurasian J Emerg Med"},{"key":"R27-20260821","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1097\/00003246-199905000-00041","article-title":"The Pediatric Risk of Mortality (PRISM) Score and Injury Severity Score (ISS) for predicting resource utilization and outcome of intensive care in pediatric trauma","volume":"27","author":"Castello","year":"1999","journal-title":"Crit Care Med"},{"key":"R28-20260821","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.ajem.2020.12.059","article-title":"A reappraisal of childhood drowning in a pediatric emergency department","volume":"41","author":"\u015e\u0131k","year":"2021","journal-title":"Am J Emerg Med"},{"key":"R29-20260821","first-page":"5","article-title":"Ratio of neutrophil to lymphocyte counts\u2013rapid and simple parameter of systemic inflammation and stress in critically ill","volume":"102","author":"Zahorec","year":"2001","journal-title":"Bratisl Lek Listy"},{"key":"R30-20260821","doi-asserted-by":"crossref","first-page":"e0022","DOI":"10.5041\/RMMJ.10376","article-title":"Are neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios associated with mortality in pediatric trauma patients? A retrospective study","volume":"10","author":"Tekin","year":"2019","journal-title":"Rambam Maimonides Med J"},{"key":"R31-20260821","first-page":"1292","article-title":"BIG score is a strong predictor of mortality and morbidity for high-energy traumas in pediatric intensive care unit","volume":"28","author":"K\u0131ht\u0131r","year":"2022","journal-title":"Turk J Trauma Emerg Surg"},{"key":"R32-20260821","doi-asserted-by":"crossref","first-page":"123","DOI":"10.54005\/geneltip.1544462","article-title":"Prognostic value of systemic immune-inflammatory index in hospitalized adolescent COVID-19 patients","volume":"35","author":"\u00c7a\u011flar","year":"2025","journal-title":"Genel T\u0131p Derg"},{"key":"R33-20260821","doi-asserted-by":"crossref","first-page":"127","DOI":"10.5144\/0256-4947.2022.127","article-title":"Neurological outcomes in adult drowning patients in China","volume":"42","author":"Zhou","year":"2022","journal-title":"Ann Saudi Med"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/PEC.0000000000003676","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T07:00:17Z","timestamp":1787295617000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/PEC.0000000000003676"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":33,"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000003676","relation":{},"ISSN":["0749-5161","1535-1815"],"issn-type":[{"value":"0749-5161","type":"print"},{"value":"1535-1815","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"assertion":[{"value":"2026-02-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-27","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}