Shenoi Rohit P, Nguyen Trung, Driscoll Colleen, Liu Kyle S, Mendez Donna, Jones Jennifer L, Camp Elizabeth A
Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine.
Department of Pediatrics, Baylor College of Medicine.
Pediatr Emerg Care. 2025 Jul 1;41(7):514-520. doi: 10.1097/PEC.0000000000003382. Epub 2025 Mar 25.
Drowning is a leading cause of unintentional injury death in children in the United States. There is a need to identify prehospital factors that affect drowning outcomes. We sought to study prehospital and resuscitation factors associated with favorable neurological outcomes at hospital discharge among pediatric drowning patients.
This was a retrospective study of drowning patients younger than 18 years in an urban area from 2010 to 2017. Submersion, prehospital, and patient data were obtained from hospital, Emergency Medical Services, and fatality records. The outcome was classified as favorable or poor neurological status at hospital discharge based on the Cerebral Performance Category (CPC). Logistic regression determined prehospital predictors associated with favorable outcomes.
There were 803 submersions; outcomes were available in 759 (94.5%) cases. The median age was 3 years (IQR: 2, 5), and 60% were males. Eighty-four percent of patients had favorable neurological outcomes at hospital discharge. Bivariate analysis revealed that age <5 years, drowning in constructed bodies of water, witnessed drownings, supervisor present, submersions of 0 to 5 minutes duration, non-Emergency Medical Services transport, or absence of bystander cardiopulmonary resuscitation (BCPR) were associated with favorable outcomes. Predictive factors for favorable outcomes included supervisor presence, drowning in constructed bodies of water, submersion of 0 to 5 minutes, or no BCPR. Patients in cardiac arrest who attained return of spontaneous circulation at the emergency department arrival had higher odds of a favorable outcome than patients who did not attain a return of spontaneous circulation [OR: 6.6 (95% CI: 1.9-28.3)]. No association between bystander resuscitation and favorable outcomes in patients in cardiac arrest due to drowning [OR: 2.98 (95% CI: 0.31-145.81)] was observed.
In an urban area, pediatric drowning patients who have a supervisor present, with brief submersion times, and who drown in constructed bodies of water are more likely to experience favorable neurological outcomes at hospital discharge. No association between BCPR and favorable pediatric drowning outcomes was observed.
在美国，溺水是儿童意外受伤死亡的主要原因。有必要确定影响溺水预后的院前因素。我们试图研究与小儿溺水患者出院时良好神经功能预后相关的院前及复苏因素。
这是一项对2010年至2017年城市地区18岁以下溺水患者的回顾性研究。淹没情况、院前及患者数据来自医院、紧急医疗服务部门和死亡记录。结局根据脑功能分类（CPC）分为出院时神经功能良好或不良。逻辑回归确定与良好结局相关的院前预测因素。
共有803例溺水事件；759例（94.5%）有结局数据。中位年龄为3岁（四分位间距：2，5），60%为男性。84%的患者出院时神经功能良好。双变量分析显示，年龄<5岁、在人工水体中溺水、溺水有目击者、有监护人在场、淹没持续时间为0至5分钟、非紧急医疗服务转运或无旁观者心肺复苏（BCPR）与良好结局相关。良好结局的预测因素包括监护人在场、在人工水体中溺水、淹没持续时间为0至5分钟或无BCPR。到达急诊科时恢复自主循环的心脏骤停患者比未恢复自主循环的患者有更好结局的几率更高[比值比：6.6（95%置信区间：1.9 - 28.3）]。未观察到旁观者复苏与溺水所致心脏骤停患者良好结局之间的关联[比值比：2.98（95%置信区间：0.31 - 145.81）]。
在城市地区，有监护人在场、淹没时间短且在人工水体中溺水的小儿溺水患者出院时更有可能获得良好的神经功能结局。未观察到BCPR与小儿溺水良好结局之间的关联。
