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Traumatic Injuries and Radiographic Study Utilization Among Children With Drowning Presenting to U.S. Pediatric
Samaa Kemal1, Sriram Ramgopal2, Michelle L Macy2
1Division of Emergency Medicine (S Kemal, S Ramgopal, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Pediatrics (S Kemal, S Ramgopal, and ML Macy), Northwestern University Feinberg School of Medicine, Chicago, Ill.
Insights
Traumatic injuries are rare in pediatric drowning cases, affecting only 2.3% of children. Further research is needed to optimize diagnostic imaging use in these rare drowning injury events.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Public Health
Background:
- The occurrence and impact of traumatic injuries in pediatric drowning incidents are not well-documented.
- Understanding these injuries is crucial for appropriate medical care and resource allocation in pediatric hospitals.
Purpose of the Study:
- To determine the incidence of clinically significant traumatic injuries in children treated for drowning.
- To characterize the diagnostic imaging utilized in these pediatric drowning cases.
Main Methods:
- A retrospective analysis of 10,397 pediatric drowning encounters from October 2015 to December 2020 across 45 hospitals.
- Inclusion criteria: children (≤18 years) with a drowning event.
- Data collected on traumatic injuries (brain, spine, torso, etc.), patient demographics, and radiographic testing, with statistical comparisons between injured and uninjured groups.
Main Results:
- Clinically important traumatic injuries were identified in 2.3% of pediatric drowning encounters.
- Intracranial injury was the most frequent (1.0%), with other injuries occurring in ≤0.5%.
- Computerized tomography (CT) scans were performed in varying proportions for different body regions, with brain CT being the most common (11.4%).
Conclusions:
- Clinically significant traumatic injuries are uncommon in pediatric drowning cases.
- The findings suggest a need for further investigation to establish optimal guidelines for radiographic study utilization in this patient population.
Objective:
The role of traumatic injuries in fatal and nonfatal drownings is poorly described. We sought to characterize the incidence of traumatic injuries and diagnostic imaging performed among children who received pediatric hospital care for drowning.
Methods:
We conducted a retrospective study of children (≤18 years) with drowning encounters at 45 pediatric hospitals, October 2015 through December 2020. We described the presence of clinically important traumatic injuries to the following body regions: brain, spinal cord, thoracic and intra-abdominal organs, axial skeleton, pelvis, and long bones, and major vessels. We described patient characteristics and radiographic testing. We compared patients with and without traumatic injuries using the Fisher's exact and Wilcoxon signed rank tests.
Results:
We identified 10,397 children with a drowning encounter. Most (83.4%) were treated in the emergency department and 52.8% were admitted. There were 238 (2.3%) encounters with clinically important traumatic injuries. Intracranial injury was the most common (1.0%) with other traumatic injuries occurring in ≤0.5%. Less than 2% of children had a moderate or severe injury severity score and approximately half of these children had a clinically important traumatic injury. Among children with traumatic injuries, a higher proportion were 10 to 14 or 15 to 18 years old and from ZIP codes with lower median household income. Computerized tomography imaging was performed in the following proportions: brain (11.4%), cervical spine (3.7%), abdomen/pelvis (1.2%), chest (0.5%) and face/orbits (0.2%).
Conclusions:
Clinically important traumatic injuries in children with drowning are rare. Further studies are needed to guide the optimal utilization of radiographic studies in this population.
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