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Demographic factors and their association with outcomes in pediatric submersion injury
Lois K Lee1, Cheng Mao, Kimberly M Thompson
1Department of Medicine, Division of Emergency Medicine, Children's Hospital, Boston, MA 02115, USA. lois.lee@childrens.harvard.edu
Insights
Serious pediatric submersion injuries often result in death or discharge home. Injury prevention should target males, African Americans, and consider age, gender, and race/ethnicity differences.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Epidemiology
Background:
- Submersion injuries are a significant cause of pediatric morbidity and mortality.
- Understanding the epidemiology and risk factors is crucial for effective prevention strategies.
Purpose of the Study:
- To describe the epidemiology and outcomes of serious pediatric submersion injuries.
- To identify factors associated with increased risk of death or chronic disability.
Main Methods:
- Retrospective review of Massachusetts death and hospital discharge data (1994-2000).
- Inclusion of residents aged 0-19 years with unintentional submersion injuries.
- Logistic regression analysis to correlate outcomes with demographic and risk factors.
Main Results:
- 267 cases of serious submersion injury identified; 47% resulted in drowning, 44% discharged home.
- Younger age groups showed improved outcomes (p < 0.0001).
- Increased risk of poor outcome for males (OR: 2.52) and African Americans (OR: 3.47); decreased risk for Hispanics (OR: 0.056) compared to whites.
Conclusions:
- Pediatric submersion injury outcomes are largely bimodal: death or discharge home.
- Younger age, female gender, and Hispanic ethnicity were associated with better outcomes.
- Targeted injury prevention efforts considering age, gender, and race/ethnicity are recommended.
Objectives:
To describe the epidemiology and outcomes of serious pediatric submersion injuries and to identify factors associated with an increased risk of death or chronic disability.
Methods:
A retrospective database review of 1994-2000 Massachusetts death and hospital discharge data characterized demographic factors; International Classification of Diseases, Ninth Revision (ICD-9), Clinical Modification (ICD-9-CM), or ICD-10 injury codes; and outcomes for state residents 0-19 years of age identified with unintentional submersion injuries. The authors performed logistic regression analysis to correlate outcomes with risk and demographic factors.
Results:
The database included 267 cases of serious submersion injury, defined as those requiring hospitalization or leading to death. Of these 267 patients, 125 (47%) drowned, 118 (44%) were discharged home, 13 (5%) were discharged home with intravenous therapy or with availability of a home health aide, and 11 (4%) were discharged to an intermediate care/chronic care facility. The authors observed a trend of improved outcome in successively younger age groups (p < 0.0001). The multivariable logistic regression analysis showed an increased likelihood of poor outcome for males compared with females (odds ratio [OR]: 2.52; 95% confidence interval [95% CI] = 1.31 to 4.84) and for African Americans compared with whites (OR: 3.47; 95% CI = 1.24 to 9.75), and a decreased likelihood of poor outcome for Hispanics compared with whites (OR: 0.056; 95% CI = 0.013 to 0.24).
Conclusions:
After serious pediatric submersion injuries, the overall outcome appears largely bimodal, with children primarily discharged home or dying. The observations that better outcomes occurred among younger age groups, females, and Hispanic children, with worse outcomes in African American children, suggest that injury prevention for submersion injuries should consider differences in age, gender, and race/ethnicity.
