Pediatric Drowning and Prehospital Predictors of Critical Illness in the United States.

Abstract

Objective: Drowning is a leading cause of injury-related death for US children. The study objectives are to describe the characteristics of pediatric drowning patients receiving emergency medical services (EMS) care in the United States and to identify patient-specific and incident-specific variables associated with critical illness after drowning.

Methods: This is a cross-sectional study using the 2019 National Emergency Medical Services Information System database. Children below 19 years old with international classification of diseases 10 external cause of injury (E-codes) for drowning were included. Critical illness was defined as a recorded Glasgow Coma Scale score <9 at any time during EMS care. We performed multivariable logistic regression reporting odds ratios (OR) and 95% CI for the outcome of critical illness controlling for demographic and incident characteristics.

Results: Our study sample included 1052 patients, and 57% were below 5 years. Critical illness after drowning was identified in 23.9% (n=251). Most drowning patients were transported via advanced life support (88.4% for noncritically ill, 87.3% for critically ill patients). Resuscitation procedures performed by EMS for these patients included the following: 12.7% with assisted ventilation, 6.7% with advanced airway management, and 17.8% with cardiopulmonary resuscitation. There were increased odds of critical illness in males (OR 1.41, 95% CI: 1.03, 1.93) and in children below 1 year (OR 2.54, 95% CI: 1.26, 5.10) and 1 to 4 years (OR 1.61, 95% CI: 1.01, 2.56) compared with 13 to 19 years and decreased odds for urban location (OR 0.60, 95% CI: 0.39, 0.91).

Conclusions: Among children receiving EMS care after drowning, 23.9% were critically ill, and predictors of critical illness included male sex, young age, and nonurban locations. Using national EMS data is a novel approach to inform prehospital and emergency department preparedness to improve care for pediatric patients after drowning including pediatric resuscitation procedures by EMS personnel.