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Factors Associated with Pediatric Drowning-Associated Lung Injury
Rohit P Shenoi1, James E Crowe2, Scott R Dorfman2
1Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
Insights
Older children, prolonged submersion, and abnormal vital signs increase the risk of clinically-important drowning-associated lung injury (ciDALI). Early resuscitation and prompt medical evaluation are crucial for pediatric drowning victims.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Toxicology
Background:
- Drowning is a leading cause of injury-related death in children.
- Clinically-important drowning-associated lung injury (ciDALI) represents a significant morbidity.
- Identifying risk factors for ciDALI is crucial for timely intervention and improved outcomes.
Purpose of the Study:
- To identify risk factors associated with clinically-important drowning-associated lung injury (ciDALI) in pediatric patients.
- To inform clinical decision-making and resource allocation in pediatric drowning cases.
Main Methods:
- A cross-sectional study involving 4213 pediatric patients (0-18 years) across 32 pediatric emergency departments from 2010-2017.
- Data collected included demographics, comorbidities, prehospital care, chest radiographs, and emergency department course.
- ciDALI was defined by specific criteria including mortality, oxygen requirements, ventilatory support, or abnormal chest imaging.
Main Results:
- 28% of patients (1168/4213) experienced ciDALI.
- Risk factors for ciDALI included: older age (>5 years), prolonged submersion (>5 minutes), scene resuscitation, and abnormal presentation findings (mentation, heart rate, respiratory rate, hypotension, lung auscultation).
- Specific odds ratios highlighted significant associations, e.g., abnormal mentation (aOR: 6.4) and prolonged submersion (aOR: 6.0).
Conclusions:
- Pediatric ciDALI is associated with older age, scene resuscitation, prolonged submersion, and abnormal pulmonary, hemodynamic, and neurological status upon emergency department presentation.
- Further prospective research is needed to stratify risks and optimize patient management and disposition following submersion injuries.
- These findings underscore the importance of rapid assessment and intervention in pediatric drowning incidents.
Objective:
To identify risk factors for clinically-important drowning-associated lung injury (ciDALI) in children.
Study Design:
This was a cross-sectional study of children (0 through 18 years) who presented to 32 pediatric emergency departments (EDs) from 2010 through 2017. We reviewed demographics, comorbidities, prehospital data, chest radiographs reports, and ED course from emergency medical services, medical, and fatality records. We defined ciDALI as presence of any of the following: (1) drowning deaths without cerebral/cervical spine injuries; (2) supplemental oxygen >8 hours postdrowning; (3) invasive/noninvasive ventilatory support in first 24 hours; or (4) abnormal chest radiographic findings in the first 24 hours without resolution within 8 hours postdrowning. We used mixed-methods logistic regression with site as random effect to identify risk factors and bootstrapping to reduce overfitting.
Results:
We enrolled 4213 patients (no ciDALI = 3045 [72%]; ciDALI = 1168 [28%]). The median age was 3 years (IQR: 1, 5). The risk factors for patients with ciDALI were age >5 years old (aOR: 2.4 [95% CI: 2.0-3.0]); submersion >5 minutes (aOR: 6.0 [95% CI: 3.5-10.2]); any scene resuscitation (aOR: 3.3 [95% CI: 2.5-4.5]) and at presentation to the ED abnormal mentation (aOR: 6.4 [95% CI: 4.1-10.0]), abnormal heart rate (aOR: 1.8 [95% CI: 1.6-2.1]), abnormal respiratory rate (aOR: 1.8 [95% CI: 1.4-2.3]), hypotension (aOR: 2.8 [95% CI: 1.0-7.4]), and abnormal lung auscultation (OR: 3.9 [95% CI: 2.9-5.4]).
Conclusions:
Pediatric ciDALI risk factors include older age, scene resuscitation, prolonged submersion, and abnormal pulmonary, hemodynamic, and neurological findings at ED presentation. Prospective research to stratify risks based on submersion-related lung injury is needed to help determine short-term outcome and optimize patient disposition.
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