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Drowning and Nonfatal Drowning in Children and Adolescents: A Subsequent Retrospective Data Analysis
Sebastian Berger1, Manuela Siekmeyer2, Stefanie Petzold-Quinque2
1Department of Women and Child Health, Hospital for Children and Adolescents, Division of Neuropediatrics, University of Leipzig, Liebigstraße 20a, 04103 Leipzig, Germany.
Insights
Drowning remains a significant risk for children, with most incidents occurring in private pools. Outcomes have improved due to better care, but supervision remains critical for young males and those with health conditions.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Epidemiology
Background:
- Drowning is a leading cause of death and neurological impairment in children and adolescents.
- Previous research from Leipzig (1994-2008) established baseline trends in drowning incidents.
- A decade of data is needed to evaluate recent changes in risk factors, treatments, and outcomes.
Purpose of the Study:
- To analyze trends in pediatric drowning risk factors, treatments, and outcomes from 2008-2020.
- To compare current data with a preceding study at Leipzig University.
- To identify prognostic parameters for patient outcomes in drowning incidents.
Main Methods:
- Retrospective analysis of 47 pediatric inpatients (0-18 years) with ICD-10 code T75.1 at Leipzig University Department of Pediatrics (2008-2020).
- Comparison of data with a previous study from the same institution.
- Examination of prognostic value of clinical parameters for patient outcomes.
Main Results:
- Median of three drowning incidents per year; median age 2.75 years; 76% male. Incidents peaked in summer and on weekends.
- Most frequent locations were private ponds/pools (48.9%). 39 children discharged without morbidity, 4 with impairment, 3 died.
- Hospitalization duration, morbidity, and lethality decreased compared to the previous study. Improved primary care and documentation noted.
Conclusions:
- Risk factors like age, sex, and incident characteristics persist. Enhanced supervision is crucial for young males and children with pre-existing conditions near private water bodies.
- Improved outcomes suggest advancements in medical care and documentation. Prognostic indicators for good outcomes were identified.
- Further research with standardized reporting (Utstein-style) and broader patient inclusion is recommended to refine drowning epidemiology and therapy evaluation.
Abstract:
Fatal and nonfatal drowning are among the leading causes of death and lifelong severe neurological impairment among children and adolescents. This study aimed to complement research from Leipzig 1994-2008 to seek trends within risk factors, treatments, and outcomes throughout the last decade. We retrospectively investigated data of 47 inpatients aged 0-18 admitted to Leipzig University Department of Pediatrics who matched ICD-10 code T75.1 from 2008 to 2020 and compared them to a preceding study at the same institution. We also examined the prognostic value of parameters regarding the patients' outcomes. There were three median incidents per annum. The median age was 2.75 years; 76% of incidents happened in males. An accumulation was seen during the summer months and weekends. Most drowning incidents occurred in private ponds or pools (48.9%). Thirty-nine children were discharged without resulting morbidity, four showed neurological impairment, and three died. Risk factors concerning age, sex, and incident characteristics were confirmed. Special supervision needs still apply to 1-3-year-old male children or children with pre-existing health conditions around private pools and ponds. Hospitalization duration shortened, and morbidity and lethality decreased since the previous study. There was structural improvement in primary care and medical documentation. Parameters suggesting good outcomes include a submersion time < 5 min, GCS > 3 points, spontaneous movement upon admission, remaining pupillary light response, the absence of cardiovascular arrest, body temperature ≥ 32 °C, pH > 7, blood glucose < 15 mmol/L, lactate < 14 mmol/L, base excess ≥ -15 mmol/L, and the absence of ARDS. Clear legislation can contribute to improved private home water safety. Further studies should include a broad in- and outpatient spectrum and standardized incident documentation presupposing Utstein-style reporting. Regular reinvestigation of consistent geographical regions facilitates process evaluations of drowning epidemiology and therapy evolution.
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