Evaluation of demographic and clinical features of children with drowning

Introduction and Aim: This study aims to evaluate the clinical features of cases presenting with drowning between the years 2008 and 2016, treated and followed up in the intensive care unit in the Emergency Pediatric Department, Dicle University from Diyarbakır and the surrounding cities. This study was conducted to emphasize the importance of on-land water safety training for children and drowning prevention training for parents and emergency response training for the community in preventing childhood drowning. Material and Method: 69 patients aged 0-18 who admitted with drowning, treated and followed up in the intensive care unit in the Emergency Pediatric Department, Dicle University, were retrospectively evaluated. The study included a total of 69 patients, were 42 male and 27 female, from Diyarbakır and its districts. The patients were evaluated for age, sex, urban-rural residence, season, month, neurological background, vital findings at admission, Glasgow Coma Scale, CBC, hemoglobin, platelet, urea, creatinine, ALT, AST, sodium, potassium, lactate dehydrogenase, drowning site, submersion time, hospital admission time, emergency response efficiency, hospitalization, mechanical ventilator support efficiency, treatment, follow-up, and outcome. Findings: 39.1% of the patients were female, and 60.9% male in this study. An analysis of patients' residential setting showed that 60.1% were rural, while 39.1% were urban residents. The mean age of patients were 4,1 years. Mean hospital admission time was 1.2 hours. Total intensive care hospitalization time was 687 days, with a mean value of 9.95 days. 71% of patients were aged between 0-4 years, 18,8% were aged between 5-10 years, and 10,1% were aged > 10 years. Drowning sites were 33,3% pool drowning, 27,5% bucket drowning, 17,4% well drowning, 11,6% river and creek drowning, and 8,7% lake and pond drowning. Drowning site data of one of the case was not detected. Non-accidental causes of drowning were not identified. There were no suicidal drowning cases. An analysis of drowning cases by seasons revealed that the most common (62,3%) occurrences were during the summer season. This was followed by 17.4% drowning in the spring, 14,5% autumn, and 5,8% drowning in the winter season. An analysis of drownings by months showed that 18,8% of the incidents occurred in July, 14,5% in August, 13% in June and September, which was in conformity with seasonal findings. An analysis was made for overall condition at hospital admission and the level of shortness of breath. While 59,4% of the cases were in poor overall condition at admission, with no spontaneous respiration, and intubated, 36,2% were in fair-good overall condition, with spontaneous respiration but pulmonary auscultation findings, and 4,3% were in good overall condition, with no pulmonary auscultation findings. The Glasgow Coma Scale (GCS) scores at hospital admission were analyzed. 36.2%f of the cases had a coma score of <5, 14.5% of the cases had a coma score of 5-10, and 42% of the cases had a coma score of >10 and over. The mean peak heart rate (PHR) was found to be 125,6±28,99 at hospital admission. The mean breath-per-minute (BPM) of patients with spontaneous respiration was found to 25,02±12,88. The BPM and PHR levels of drowning cases by age were found to be within normal limits. An analysis of hospitalization times revealed a mean hospitalization time of 9.95 days, while 60,9% of the patients were hospitalized for <5 days, 15,9% of the cases were hospitalized between 5-10 days, and 23,2% of the cases were hospitalized for >10 days. 53,6% of the patients received mechanical ventilator support at the intensive care unit. 27,5% of the cases received emergency response at the time of the incident. The mortality correlation of patients who received basic life support was analyzed and the difference (p<0.05) was found to be meaningful. It was also found that there was a dramatic decrease in the percentage of recovering patients with extended submersion times. The correlation between submersion time and mortality was found to be meaningful (p<0,05). Conclusion: The follow-up and treatment of most of the drowning and cases are being handled at intensive care units. The major cause of drowning is accidental drowning and the children's accidental falling into the water due to lack of parental attention. The number of adolescent suicidal drowning cases is fewer. Life Saving Training to rescue the drowning individual without risking one's life and first aid trainings applicable to drowning individuals, and both retrospective and prospective determination of nationwide epidemiological characteristics through multicenter survey in addition to the measures to be taken by parents and governmental authorities will significantly contribute to the prevention of childhood drownings, and reduction of childhood mortality and morbidity. Keywords: Drowning, prevention, child