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Children under 5 years presenting to paediatricians with near-drowning
F I Ross1, E J Elliott, L T Lam
1Trauma Research Unit, The Children's Hospital at Westmead, New South Wales, Australia. FrankR@CHW.edu.au
Insights
Most near-drowning incidents involving children under 5 occur at home, with toddlers and males at higher risk. This national study highlights the need for improved supervision and community education to prevent these severe events.
Area of Science:
- Pediatric Emergency Medicine
- Public Health Surveillance
- Child Safety
Background:
- Near-drowning incidents in children under 5 years old represent a significant public health concern.
- Understanding the demographics and circumstances surrounding these events is crucial for effective prevention strategies.
Purpose of the Study:
- To characterize children under 5 presenting with near-drowning.
- To identify high-risk groups and circumstances.
- To document short-term outcomes of near-drowning events.
Main Methods:
- Utilized monthly notifications to the Australian Paediatric Surveillance Unit (APSU) from 1994-1996.
- Collected additional case data via postal questionnaires from reporting pediatricians.
- Analyzed data from 169 reported cases of near-drowning.
Main Results:
- All 169 cases required hospitalization, with 15% needing intensive care.
- The average age was 26 months; 22% were 12-18 months old. Males predominated (1.6:1).
- Most incidents (82%) occurred at home (pools/baths), with younger children at higher risk in home environments. 7% experienced neurological damage.
Conclusions:
- Near-drowning cases presenting to pediatricians represent severe incidents with significant hospitalization and adverse neurological outcomes.
- Home environments, particularly swimming pools and baths, are the primary locations for near-drownings.
- Males and toddlers are at increased risk, emphasizing the need for enhanced supervision and community education on prevention.
Objective:
To characterize children aged under 5 years who present to paediatricians following near-drowning and the circumstances surrounding the event, identify high-risk groups and document short-term outcome.
Methodology:
Monthly notifications to the Australian Paediatric Surveillance Unit (an active, national surveillance system) between 1994 and 1996. Collection of additional case information from reporting doctors by postal questionnaire.
Results:
All 169 reported cases of near-drowning were admitted to hospital (mean (SD) stay 6 (17) days) and 15% required intensive care (mean (SD) stay 19 (32) days). The mean (SD) age for near drowning was 26 (13) months and 22% children were aged between 12 and 18 months. Males predominated (1.6:1) and 69 (41%) of episodes occurred in summer (December - February). The majority (82%) of near-drownings occurred in the child's home, usually in a swimming pool or bath. Children who nearly drowned at home were significantly younger than those who nearly drowned in natural waterways or public pools. Neurological damage at discharge following near-drowning was reported in 7%.
Conclusions:
Children reported in this national case series represent the severe end of the spectrum of those who nearly drown, as indicated by their presentation to a paediatrician, universal hospitalization and adverse neurological outcome. The home is the site of most near-drownings and males and toddlers were at particular risk. Unimpeded access to pools and lack of supervision were identified as potentially modifiable factors for prevention. The study suggests the need for additional community education regarding the risks of near-drowning and for further research on long-term neuro-developmental outcomes following near-drowning.