Pediatric near-drowning events

do they warrant trauma team activation?

Pranit N. Chotai, Lisa Manning, Benjamin Eithun, Joshua C. Ross, James Eubanks, Chad Hamner, Ankush Gosain

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background The purpose of this study was to determine the incidence of traumatic injuries, factors associated with mortality, and need for pediatric trauma surgery involvement for drowning and near-drowning events in children. Materials and methods An institutional review board–approved, retrospective chart review was performed at three American College of Surgeons–verified Pediatric Trauma Centers (2011-2014). Patients with International Classification of Diseases, Ninth Revision, codes or E-codes for fatal–nonfatal drowning, fall into water, accidental drowning, or submersion were included. Bivariate analysis using chi-square or Fisher exact test for nominal variables and Mann–Whitney U test for continuous variables was performed. Results A total of 363 patients (median 3.17 y [18 d-17 y]) met the inclusion criteria. Drowning sites included pool (81.5%), bathtub (12.9%), and natural water (5.2%). A witnessed fall or dive was reported in 34.9%, 57.9% did not fall or dive, and 7% had an unwitnessed event. Most patients did not undergo cervical spine (83%) or brain imaging (75.5%). Seven patients (1.92%) had associated soft tissue injuries. Two patients (0.006%) received surgical intervention (bronchoscopy and extracorporeal membrane oxygenation) within 24 h of presentation. Only 2.2% were admitted to the pediatric trauma service. The percentage of patients discharged home from the emergency department was 10.2%. Overall mortality was 12.4%. Factors associated with mortality included transfer from outside hospital (P = 0.016), presence of hypothermia on arrival (P < 0.0001), Glasgow Coma Scale of 3 on arrival (P < 0.0001), drowning in a pool (P = 0.013), or undergoing brain cooling at admission (P = 0.011). Conclusions This is the largest reported series of pediatric near-drowning events. Only rarely did patients require immediate surgical attention and the majority were admitted to nonsurgical services. These data suggest that routine pediatric trauma surgery service involvement in patients with near-drowning events may be unnecessary.

Original languageEnglish (US)
Pages (from-to)108-113
Number of pages6
JournalJournal of Surgical Research
Volume212
DOIs
StatePublished - May 15 2017

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Near Drowning
Pediatrics
Wounds and Injuries
Mortality
Soft Tissue Injuries
Extracorporeal Membrane Oxygenation
Glasgow Coma Scale
Water
Trauma Centers
Bronchoscopy
International Classification of Diseases
Immersion
Hypothermia
Neuroimaging
Hospital Emergency Service
Spine

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Pediatric near-drowning events : do they warrant trauma team activation? / Chotai, Pranit N.; Manning, Lisa; Eithun, Benjamin; Ross, Joshua C.; Eubanks, James; Hamner, Chad; Gosain, Ankush.

In: Journal of Surgical Research, Vol. 212, 15.05.2017, p. 108-113.

Research output: Contribution to journalArticle

Chotai, Pranit N. ; Manning, Lisa ; Eithun, Benjamin ; Ross, Joshua C. ; Eubanks, James ; Hamner, Chad ; Gosain, Ankush. / Pediatric near-drowning events : do they warrant trauma team activation?. In: Journal of Surgical Research. 2017 ; Vol. 212. pp. 108-113.
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title = "Pediatric near-drowning events: do they warrant trauma team activation?",
abstract = "Background The purpose of this study was to determine the incidence of traumatic injuries, factors associated with mortality, and need for pediatric trauma surgery involvement for drowning and near-drowning events in children. Materials and methods An institutional review board–approved, retrospective chart review was performed at three American College of Surgeons–verified Pediatric Trauma Centers (2011-2014). Patients with International Classification of Diseases, Ninth Revision, codes or E-codes for fatal–nonfatal drowning, fall into water, accidental drowning, or submersion were included. Bivariate analysis using chi-square or Fisher exact test for nominal variables and Mann–Whitney U test for continuous variables was performed. Results A total of 363 patients (median 3.17 y [18 d-17 y]) met the inclusion criteria. Drowning sites included pool (81.5{\%}), bathtub (12.9{\%}), and natural water (5.2{\%}). A witnessed fall or dive was reported in 34.9{\%}, 57.9{\%} did not fall or dive, and 7{\%} had an unwitnessed event. Most patients did not undergo cervical spine (83{\%}) or brain imaging (75.5{\%}). Seven patients (1.92{\%}) had associated soft tissue injuries. Two patients (0.006{\%}) received surgical intervention (bronchoscopy and extracorporeal membrane oxygenation) within 24 h of presentation. Only 2.2{\%} were admitted to the pediatric trauma service. The percentage of patients discharged home from the emergency department was 10.2{\%}. Overall mortality was 12.4{\%}. Factors associated with mortality included transfer from outside hospital (P = 0.016), presence of hypothermia on arrival (P < 0.0001), Glasgow Coma Scale of 3 on arrival (P < 0.0001), drowning in a pool (P = 0.013), or undergoing brain cooling at admission (P = 0.011). Conclusions This is the largest reported series of pediatric near-drowning events. Only rarely did patients require immediate surgical attention and the majority were admitted to nonsurgical services. These data suggest that routine pediatric trauma surgery service involvement in patients with near-drowning events may be unnecessary.",
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