Joanknecht L, Argent A C, van Dijk M, van As A B
ErasmusMC, Room SK1276, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands,
Pediatr Surg Int. 2015 Feb;31(2):123-30. doi: 10.1007/s00383-014-3637-0. Epub 2014 Nov 18.
Drowning is an important cause of childhood injury, however, little is known about drowning in Africa. The aim of this study is to investigate submersion incidents in Cape Town, South Africa and provide specific prognostic factors as well as to develop age-appropriate prevention strategies.
A retrospective chart review performed at the Red Cross War Memorial Children's Hospital in Cape Town, South Africa. Patients admitted because of 'drowning' or 'near-drowning' between January 2007 and April 2013 were included.
75 children were included. 63 (84 %) survived without complications, 8 (10.7 %) died and 4 (5.3 %) had permanent neurological sequelae. The median age was 2.2 years (range 0.1-12.4). 46 (60.5 %) incidents happened in or around the home, only 14 (18.7 %) were witnessed. 42 (56 %) took place in a pool (29 private, 13 public). Significant predictors of the outcome were: estimated submersion time, duration of apnea, unresponsive and dilated pupils, intubation and use of inotropes. On arrival at the ER we found these significant predictors of the outcome: CPR, a GCS <5, hypothermia, bradycardia, asystole, as well as the PIM2-calculated mortality risk for patients admitted to the ICU.
The majority of incidents were unwitnessed and occurred in or around the home. Prevention programs should be focused on adult supervision for younger children and creating awareness on the dangers of drowning in the home environment. While bathing in baths or buckets, children should never be left alone and parents should be made aware of the dangers. In our study, the majority of incidents occurred in swimming pools and limiting access to these could prevent many incidents of drowning among older children. Although children of all language groups are at risk for drowning, English- or Afrikaans-speaking children were particularly at risk for drowning in private pools while Xhosa-speaking children mostly drowned in baths or buckets. We also report multiple prognostic factors for the outcome, but none of them were absolute predictive of the outcome, indicating that each victim of submersion deserves full resuscitative treatment.
溺水是儿童伤害的一个重要原因，然而，关于非洲的溺水情况人们知之甚少。本研究的目的是调查南非开普敦的溺水事件，提供具体的预后因素，并制定适合不同年龄段的预防策略。
在南非开普敦的红十字战争纪念儿童医院进行了一项回顾性病历审查。纳入2007年1月至2013年4月期间因“溺水”或“近乎溺水”入院的患者。
共纳入75名儿童。63名（84%）存活且无并发症，8名（10.7%）死亡，4名（5.3%）有永久性神经后遗症。中位年龄为2.2岁（范围0.1 - 12.4岁）。46起（60.5%）事件发生在家中或家附近，仅有14起（18.7%）有目击者。42起（56%）发生在游泳池（29起在私人游泳池，13起在公共游泳池）。预后的重要预测因素包括：估计的溺水时间、呼吸暂停持续时间、无反应和瞳孔散大、插管以及使用血管活性药物。在到达急诊室时，我们发现这些预后的重要预测因素：心肺复苏、格拉斯哥昏迷评分<5、体温过低、心动过缓、心搏停止，以及入住重症监护病房患者的儿科死亡率指数2计算出的死亡风险。
大多数事件无目击者，且发生在家中或家附近。预防项目应侧重于对年幼儿童的成人监管，并提高对家庭环境中溺水危险的认识。在浴缸或水桶中洗澡时，绝不能让儿童独处，应让家长意识到其中的危险。在我们的研究中，大多数事件发生在游泳池，限制进入这些地方可预防许多大龄儿童溺水事件。尽管所有语言群体的儿童都有溺水风险，但说英语或南非荷兰语的儿童在私人游泳池溺水的风险尤其高，而说科萨语的儿童大多在浴缸或水桶中溺水。我们还报告了多个预后因素，但没有一个是结果的绝对预测指标，这表明每个溺水受害者都应接受充分的复苏治疗。
