P. N. Chotai1, B. Eithun2, L. Manning1, J. Ross3, J. W. Eubanks1, A. Gosain1 1Univeristy Of Tennessee Health Science Center,Pediatric Surgery, Le Bonheur Children’s Hospital,Memphis, TN, USA 2University Of Wisconsin,Pediatric Trauma Program, American Family Children’s Hospital,Madison, WI, USA 3University Of Wisconsin,Division Of Pediatric Emergency Medicine, Department Of Emergency Medicine, American Family Children’s Hospital,Madison, WI, USA
Introduction:
Drowning and near-drowning events remain a leading cause of accidental deaths in children. Currently, many American College of Surgeons (ACS) designated pediatric trauma centers activate the trauma team on receipt of drowning or near-drowning patients. The purpose of this study is to determine the incidence of traumatic injuries, factors associated with mortality and need for Pediatric Trauma Surgery involvement for children involved in drowning and near-drowning events.
Methods:
Following IRB approval, retrospective chart review was performed for patients presenting with drowning and near-drowning events at either of the two ACS Level I Pediatric Trauma Centers between 1/1/2011-12/31/2014. Patients with ICD-9 codes for fatal/nonfatal drowning or E-codes for fall into water, accidental drowning, or submersion were included. Patient demographics, drowning characteristics, level of trauma activation, transfer, Glasgow coma scale (GCS) and body temperature at arrival, cervical spine and head imaging, admission and discharge details, mortality, need for surgical intervention in first 24 hours, and other associated injuries were recorded. Univariate analysis using chi-square or Fisher exact test for nominal variables and student t-test for continuous variables was performed.
Results:
104 patients, with a median age of 4.0 years (range, 18 days to 17 years), met the inclusion criteria. 27 (26%) were female and 77 (74%) were male. The most frequent site of drowning was the pool (78.1%), followed by bathtub (14.4%), and natural water (6.7%). A witnessed fall or dive was reported in 35.6% patients, 39.4% patients did not fall or dive and 25% had an unwitnessed near-drowning event. Most (72.1%) patients did not undergo any cervical spine imaging. Brain/Head imaging was obtained in 33.7% patients. Notably, none of the patients, at either site, required any form of surgical intervention in the first 24 hours after presentation, other than placement of monitoring lines. Only 6.7% patients were admitted to the Pediatric Trauma Surgery service. The majority of patients (59.6%) were admitted to the pediatric intensive care unit, or to general pediatric floor (34.6%). A small proportion of patients (5.8%) were discharged home from the emergency department. Overall mortality was 17.3%. Factors associated with mortality included transfer from outside hospital (p=0.016), presence of hypothermia on arrival (p<0.0001), GCS of 3 on arrival (p<0.0001), or drowning in a pool compared to bathtub or freshwater (p=0.013).
Conclusion:
The incidence of associated traumatic injury in drowning and near drowning patients is low. In this series, we did not find any traumatic injures requiring immediate surgical attention. Additionally, the majority of patients are admitted to non-surgical services for their inpatient management. These data suggest that routine Pediatric Trauma Surgery service involvement in patients with near-drowning accidents may be unnecessary.