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A reappraisal of childhood drowning in a pediatric emergency department
Nihan Şık1, Hüseyin Bahadır Şenol2, Ali Öztürk1
1Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey.
Insights
Pediatric drowning patients with higher Szpilman scores, lung crepitations, and abnormal chest X-rays require hospital admission. Early non-invasive ventilation (NIV) in emergency settings reduced hospital stays for drowning victims.
Area of Science:
- Pediatric Emergency Medicine
- Drowning Victim Management
- Clinical Outcomes Research
Background:
- Drowning is a significant cause of pediatric injury and mortality.
- Understanding predictors of severity and outcomes in pediatric drowning is crucial for effective management.
- Current literature lacks comprehensive analysis of demographic, clinical, and radiologic factors in pediatric drowning cases.
Purpose of the Study:
- To investigate demographic and clinical features of pediatric drowning patients.
- To identify predictors of hospital admission and need for respiratory support.
- To evaluate the prognosis and outcomes of pediatric drowning cases.
Main Methods:
- Retrospective chart review of pediatric drowning patients (0-18 years) from July 2009 to September 2019.
- Data collected included demographics, vital signs, clinical findings, laboratory results, and respiratory support needs.
- Patients were classified using the Szpilman drowning scale.
Main Results:
- Szpilman score ≥4, elevated lactate (>2 mmol/L), and abnormal chest X-ray predicted hospital admission.
- Children admitted had higher Szpilman scores, lung crepitations, and abnormal chest X-rays, with lower Glasgow Coma Scale and SpO2.
- Non-invasive ventilation (NIV) was used in 24.7% of patients and correlated with shorter PICU and hospital stays.
Conclusions:
- The Szpilman score aids in rapid decision-making for ventilation strategies and predicts hospital stay duration and hypoxia severity.
- Early application of NIV in pediatric emergency departments can reduce intensive care unit and overall hospital length of stay.
Background:
In the present study, we aimed to investigate the demographic and clinical features, laboratory and radiologic characteristics, management, and outcomes of pediatric drowning patients in order to identify predictors of hospital admission, and to evaluate the need for respiratory support, and prognosis.
Methods:
In this retrospective chart review, children aged 0 to 18 years who presented to the pediatric emergency department due to drowning between July 2009 and September 2019 were included. Demographics, initial vital signs, clinical findings, laboratory and radiologic results, and the need for respiratory support or cardiopulmonary resuscitation in the emergency department were recorded. Subjects were divided into 6 groups using the Szpilman classification system.
Results:
A total of 89 patients were enrolled. Among the children who were admitted to the hospital, initial Szpilman score, crepitations on lung auscultation, and pathologic chest X-ray (CXR) findings were higher and Glasgow Coma Score and oxygen saturation (SpO 2) levels were lower than those of children who were discharged from the emergency department. A Szpilman score of ≥4, a lactate level of >2 mmol/L, and pathologic CXR findings were identified as predictors of hospital admission. Of the 89 patients, 22 (24.7%) underwent non-invasive ventilation (NIV) treatment and were classified as grade 3 or 4 according to the Szpilman score. Length of stay in the pediatric intensive care unit (PICU) and in the hospital was lower in patients who underwent NIV. As the Szpilman score increased as of grade 3, a positive correlation was observed with lactate levels (p <0.001, r: 0.552) and the total length of stay in the hospital (p: 0.001, r : 0.491), both of which gradually increased.
Conclusion:
The Szpilman score was associated with the duration of hospital stay and the degree of hypoxia, so it could help the physician make rapid decisions on ventilation strategy. Application of NIV in the emergency department shortened the length of stay in the PICU and in the hospital, suggesting that it can be used more often in pediatric emergency settings.
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