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Inflicted submersion in childhood
J M Gillenwater1, L Quan, K W Feldman
1Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, USA.
Insights
A significant portion of pediatric submersion injuries are inflicted, not accidental. Healthcare providers should carefully evaluate bathtub submersions and cases with signs of abuse to identify potential child abuse.
Area of Science:
- Pediatric Medicine
- Forensic Pathology
- Child Abuse and Neglect
Background:
- Submersion injuries are a leading cause of accidental death in children.
- Distinguishing between accidental and inflicted submersion injuries is crucial for appropriate intervention.
Purpose of the Study:
- To enhance the characterization and recognition of inflicted pediatric submersions.
- To identify factors associated with inflicted versus unintentional submersion events.
Main Methods:
- Retrospective case series analyzing records from a regional children's hospital and a medical examiner's office.
- Two pediatricians reviewed cases of children younger than 19 years hospitalized or autopsied for submersion injury between 1983 and 1991.
- Case scenarios were categorized as inflicted or unintentional based on preestablished criteria, followed by comparative analysis.
Main Results:
- Of 205 submersion cases, 16 (8%) were classified as inflicted.
- Inflicted submersions frequently involved young children (median age 2.1 years) and occurred in bathtubs (56%).
- Signs of abuse and historical inconsistencies were common in inflicted cases; victims were less likely to be revived and more likely to die.
Conclusions:
- Inflicted pediatric submersions represent a notable proportion of cases and necessitate careful evaluation.
- Bathtub submersions and presentations with physical or historical indicators of abuse warrant heightened suspicion for inflicted injury.
Objective:
To improve characterization and recognition of inflicted pediatric submersions.
Design:
Retrospective case series, records review.
Setting:
A regional children's hospital and the King County (Washington) Medical Examiner's office.
Patients:
Children younger than 19 years who sustained submersion injury between 1983 and 1991 and were hospitalized or autopsied.
Outcome Measures:
Two pediatricians, using preestablished criteria, categorized abstracted case scenarios as either inflicted or unintentional events. The two groups were compared.
Results:
Of 205 submersions, 16 (8%) were judged to have been inflicted. Objective physical signs of abuse and incompatibilities between the history and the child's stage of development or physical findings were common (69% and 50%, respectively). Inflicted submersion victims were likely to be young (median age, 2.1 years). They tended to be the youngest sibling in a large (three or more children) household. Social and demographic attributes of inflicted and unintentional submersion victims did not differ significantly. Bathtubs were the most common site for inflicted submersions (9/16 [56%]), and submersions in bathtubs were frequently inflicted (9/34 [26%]). Compared with unintentional submersion victims, children who were inflicted submersion victims were less likely to be revived by bystanders (relative risk, 0.10; confidence interval, 0.01 to 0.72) and were more likely to die (relative risk, 4.32; confidence interval, 1.40 to 21.43).
Conclusions:
Enough childhood submersions are inflicted to warrant careful case evaluation. Bathtub submersion victims and children with physical and historical findings common to other forms of abuse are most likely to be the victims of inflicted submersion.