Incidence of Traumatic Injuries After Drowning in Children

Source: Kemal S , Ramgopal S , Macy ML , et al . Traumatic injuries and radiographic study utilization among children with drowning presenting to U.S. pediatric hospitals. Acad Pediatr. 2024;24(4):677-685; doi: 10.1016/j.acap.2023.09.009.Investigators from Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, conducted a retrospective study to determine the incidence of traumatic injury among children treated for drowning at US children’s hospitals and assess the use and yield of imaging studies for identifying traumatic injuries in these patients. For the study, they reviewed data in the Pediatric Health Information System (PHIS) database, which includes demographic information, procedural and diagnostic codes, and level of care data on encounters in >50 children’s hospitals in the US. ICD-10 codes were used to identify patients <18 years old, treated at 45 hospitals for drowning between 2015 and 2020. Information collected on study participants included age, mechanism of drowning, such as fall, jump, or dive into water (based on ICD-10 codes), imaging studies performed, and level of care (emergency department [ED], hospital admission, ICU admission), and disposition. ICD-10 codes also were used to identify specific, clinically important, traumatic injuries, including major brain injury, skull, facial, or long bone fractures, spinal cord, thoracic and intra-abdominal injury, and major vessel injury. The primary study outcome was rate of any traumatic injury, and specific injury, in children with drowning. Secondary outcomes included rates of imaging studies and diagnostic yield of these studies.Data were analyzed on 10,397 hospital encounters for drownings in children. Overall, 70.2% of study patients were <5 years old, 83.4% were treated in the ED, and of those treated in the ED, 52.8% were admitted; 18.8% of all participants were admitted to the ICU, and 560 (5.4%) children died. Clinically important traumatic injuries were identified in 238 (2.3%) study participants. The most common types of injury were intracranial injury, occurring in 101 children (1.0%), hemothorax and/or pneumothorax (52 patients, 0.5%) and upper extremity long bone fracture (38 patients, 0.4%). Drowning associated with a fall, jump, or dive into water was reported in 17.8% of patients with intracranial injury, 50% with cervical spinal cord injury, and 66.7% with lower spinal cord jury. Imaging studies were performed in 6,933 children (66.7%), including chest radiographs in 6,492 patients (62.4%), brain CT in 1,185 (11.4%), and cervical spine CT in 389 (3.7%). Among those in whom a chest radiograph was performed, 0.7% had a thoracic injury. Among patients with a brain CT, 4.3% had a traumatic brain injury, and a cervical spine injury or vertebral fracture was identified in 0.5% of children who had a cervical spine CT performed.The authors conclude that the rate of clinically important traumatic injuries in children with drowning was rare, and the yield of imaging studies to identify these injuries was low.Dr Bechtel has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Drowning is a leading cause of death in children, particularly for those younger than 5 years old (See AAP Grand Rounds. 2004;11[2]:20-21.)1 Rates of traumatic injuries after drowning in the pediatric population, however, are unknown. The current researchers found that the incidence of traumatic injury in this population of children was relatively low, and children who had moderate to severe Injury Severity Scores (ISS) were more likely to have traumatic injury. Additionally, older children (>9 years old), those with public insurance, and those living in a ZIP code with lower median household income also had a higher incidence of clinically significant traumatic injury after a drowning event.It is important to note that in the current study, the history of the injury mechanism did not help determine which children had a traumatic injury, as a fall, jump, or dive into water was reported in only 17.8% of patients with intracranial injury, 50% with cervical spinal cord injury, and 66.7% with lower spinal cord jury. Thus, judicious use of diagnostic imaging studies could be considered in those patients with moderate to severe ISS.There are several limitations to this study. While it had a large sample size, it is hard to generalize what is the actual incidence of traumatic injury in drowning patients: Thus, the patient sample in the current study may have been sicker that seen in general ED, and the incidence of traumatic injury in children with drowning may be even lower.There is a low incidence of clinically important traumatic injury in children with drowning.The results of the current study provide an impetus to develop a more targeted approach to radiographic studies in pediatric drowning victims. Prevention of drowning, especially as warmer weather has arrived, may be facilitated by utilizing AAP guidelines during office visits.2