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Rossouw S, Maree C, Latour JM. A quest for an integrated management system of children following a drowning incident: A review of the literature. J SPEC PEDIATR NURS 2024; 29:e12418. [PMID: 38047543 DOI: 10.1111/jspn.12418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/23/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
PURPOSE Management of children following a drowning incident is based on specific interventions which are used in the prehospital environment, the emergency department (ED) and the Paediatric Intensive Care Unit (PICU). This paper presents a review of the literature to map and describe the management and interventions used by healthcare professionals when managing a child following a drowning incident. Of specific interest was to map, synthesise and describe the management and interventions according to the different clinical domains or practice areas of healthcare professionals. DESIGN AND METHODS A traditional review of the literature was performed to appraise, map and describe information from 32 relevant articles. Four electronic databases were searched using search strings and the Boolean operators AND as well as OR. The included articles were all published in English between 2010 and 2022, as it comprised a timeline including current guidelines and practices necessary to describe management and interventions. RESULTS Concepts and phrases from the literature were used as headings to form a picture or overview of the interventions used for managing a child following a drowning incident. Information extracted from the literature was mapped under management and interventions for prehospital, the ED and the PICU and a figure was constructed to display the findings. It was evident from the literature that management and interventions are well researched, evidence-informed and discussed, but no clear arguments or examples could be found to link the interventions for integrated management from the scene of drowning through to the PICU. Cooling and/or rewarming techniques and approaches and termination of resuscitation were found to be discussed as interventions, but no evidence of integration from prehospital to the ED and beyond was found. The review also highlighted the absence of parental involvement in the management of children following a drowning incident. PRACTICE IMPLICATIONS Mapping the literature enables visualisation of management and interventions used for children following a drowning incident. Integration of these interventions can collaboratively be done by involving the healthcare practitioners to form a link or chain for integrated management from the scene of drowning through to the PICU.
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Affiliation(s)
- Seugnette Rossouw
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Carin Maree
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jos M Latour
- School-Research, Faculty of Health, University of Plymouth, Plymouth, UK
- Professor of Pediatric Nursing, Hunan Childrens' Hospital, Changsha, China
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Affiliation(s)
- Tracy E McCallin
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, The Children's Hospital of San Antonio, San Antonio, TX
| | - Mickinzie Morgan
- Department of Pediatrics, Texas Tech Health Sciences Center, Lubbock, TX
| | | | - Shabana Yusuf
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX
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Peden AE, Sarrami P, Dinh M, Lassen C, Hall B, Alkhouri H, Daniel L, Burns B. Description and prediction of outcome of drowning patients in New South Wales, Australia: protocol for a data linkage study. BMJ Open 2021; 11:e042489. [PMID: 33452197 PMCID: PMC7813289 DOI: 10.1136/bmjopen-2020-042489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Despite being a preventable cause of death, drowning is a global public health threat. Australia records an average of 288 unintentional drowning deaths per year; an estimated annual economic burden of $1.24 billion AUD ($2017). On average, a further 712 hospitalisations occur due to non-fatal drowning annually. The Australian state of New South Wales (NSW) is the most populous and accounts for 34% of the average fatal drowning burden. This study aims to explore the demographics and outcome of patients who are admitted to hospitals for drowning in NSW and also investigates prediction of patients' outcome based on accessible data. METHODS AND ANALYSIS This protocol describes a retrospective, cross-sectional data linkage study across secondary data sources for any person (adult or paediatric) who was transferred by NSW Ambulance services and/or admitted to a NSW hospital for fatal or non-fatal drowning between 1/1/2010 and 31/12/2019. The NSW Admitted Patient Data Collection will provide data on admitted patients' characteristics and provided care in NSW hospitals. In order to map patients' pathways of care, data will be linked with NSW Ambulance Data Collection and the NSW Emergency Department Data Collection. Finally patient's mortality will be assessed via linkage with NSW Mortality data, which is made up of the NSW Register of Births, Deaths and Marriages and a Cause of Death Unit Record File. Regression analyses will be used to identify predicting values of independent variables with study outcomes. ETHICS AND DISSEMINATION This study has been approved by the NSW Population & Health Services Research Ethics Committee. Results will be disseminated through peer-reviewed publications, mass media releases and at academic conferences. The study will provide outcome data for drowning patients across NSW and study results will provide data to deliver evidence-informed recommendations for improving patient care, including updating relevant guidelines.
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Affiliation(s)
- Amy E Peden
- School of Population Health, Faculty of Medicine, UNSW Sydney, Kensington, New South Wales, Australia
- Royal Life Saving Society Australia, Broadway, New South Wales, Australia
| | - Pooria Sarrami
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Michael Dinh
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
- The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | - Christine Lassen
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Benjamin Hall
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Hatem Alkhouri
- Emergency Care Institute, Agency for Clinical Innovation, St Leonards, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Lovana Daniel
- South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Burns
- The University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
- Greater Sydney Area Helicopter, Emergency Medical Service, NSW Ambulance, Sydney, New South Wales, Australia
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Cohen N, Capua T, Lahat S, Glatstein M, Sadot E, Rimon A. Predictors for hospital admission of asymptomatic to moderately symptomatic children after drowning. Eur J Pediatr 2019; 178:1379-1384. [PMID: 31312937 DOI: 10.1007/s00431-019-03429-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/01/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
Drowning is a leading cause of injury-related death worldwide, but there are limited data on the management and disposition of asymptomatic and mildly symptomatic adults and children following a drowning event. Some authors have recommended admission for all drowning victims due to the possibility of respiratory and clinical deterioration in a seemingly well patient. In order to identify predictors for admission and to establish a unified approach for management, we retrospectively collected all children ≤ 16 years old presented following a drowning event to the pediatric ED over a period of 12 years. The children were divided into two groups, those who were discharged home from the ED and those who were admitted. Seventy-one surviving and non-intubated children were asymptomatic to moderately symptomatic, and they comprised the study group. Crepitations on lung auscultation, oxygen desaturation, and respiratory distress were significantly higher in the admitted group (n = 26) compared with the discharged group (n = 45) (P < 0.05). Respiratory distress and lung crepitations were independent predictors for admission. Eventually, 30% of the hospitalized patients required oxygen therapy, but there were no cases that deteriorated and required invasive ventilation. No readmissions occurred in the group of children who were discharged from the ED.Conclusion: Children who after six hours show no respiratory distress and have normal oxygen saturation and normal auscultation can be safely discharged home. Respiratory distress and lung crepitations should both warrant the physician to consider admission of asymptomatic to moderately symptomatic children following a drowning event. An algorithm to assist patient management is proposed. What is Known: •There are few data in the literature regarding the management and disposition of asymptomatic to moderately symptomatic children after drowning. What is New: •We found that respiratory distress and lung crepitations are independent predictors for admission. An algorithm to assist patient management is proposed.
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Affiliation(s)
- Neta Cohen
- Pediatric Emergency Medicine, Sackler Faculty of Medicine, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel.
| | - Tali Capua
- Pediatric Emergency Medicine, Sackler Faculty of Medicine, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Sharon Lahat
- Department of Pediatrics, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Miguel Glatstein
- Pediatric Emergency Medicine, Sackler Faculty of Medicine, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Efraim Sadot
- Pediatric Intensive Care Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ayelet Rimon
- Pediatric Emergency Medicine, Sackler Faculty of Medicine, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel Aviv, Israel
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Sulovic LS, Pavlovic AP, Zivkovic JB, Zivkovic ZN, Filipovic-Danic SS, Trpkovic SV. Accidental Drowning: The Importance of Early Measures of Resuscitation for a Successful Outcome. Case Rep Emerg Med 2018; 2018:7525313. [PMID: 29974001 PMCID: PMC6008810 DOI: 10.1155/2018/7525313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/29/2018] [Indexed: 12/03/2022] Open
Abstract
CASE REPORT The case of a drowning teenager is described involving application of cardiopulmonary resuscitation (CPR) by an untrained rescuer in the field and fast transport to a hospital enabling a positive resuscitation outcome despite an underorganized emergency medical service in a rural area. In our case hypoxia led to extended functional disorders of the cardiovascular system, which fully recovered after adequate therapy. CONCLUSION Knowledge about BLS measures by ordinary citizens, together with continuous education of health professionals concerning modern techniques of CPR, is crucial for increasing the number of patients surviving after cardiac arrest.
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Affiliation(s)
- Ljiljana S. Sulovic
- Medical Faculty, University of Pristina in Kosovska Mitrovica, Children's Hospital, Kosovska Mitrovica, Serbia
| | - Aleksandar P. Pavlovic
- Medical Faculty, University of Pristina in Kosovska Mitrovica, Surgery Clinic, Department of Intensive Care, Kosovska Mitrovica, Serbia
| | - Jovan B. Zivkovic
- Medical Faculty, University of Pristina in Kosovska Mitrovica, Children's Hospital, Kosovska Mitrovica, Serbia
| | - Zorica N. Zivkovic
- Medical Faculty, University of Pristina in Kosovska Mitrovica, Children's Hospital, Kosovska Mitrovica, Serbia
| | - Snezana S. Filipovic-Danic
- Medical Faculty, University of Pristina in Kosovska Mitrovica, Neurological Clinic, Kosovska Mitrovica, Serbia
| | - Slađana V. Trpkovic
- Medical Faculty, University of Pristina in Kosovska Mitrovica, Surgery Clinic, Department of Intensive Care, Kosovska Mitrovica, Serbia
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Predictors of emergency department discharge following pediatric drowning. Am J Emerg Med 2018; 36:446-449. [DOI: 10.1016/j.ajem.2017.08.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022] Open
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Kriz D, Piantino J, Fields D, Williams C. Pediatric Hypothermic Submersion Injury and Protective Factors Associated with Optimal Outcome: A Case Report and Literature Review. CHILDREN-BASEL 2017; 5:children5010004. [PMID: 29280985 PMCID: PMC5789286 DOI: 10.3390/children5010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 11/25/2022]
Abstract
Drowning is the 3rd leading cause of unintentional injury death worldwide, with the highest rates of fatality among young children. Submersion injuries with cardiac arrest can lead to long-term neurologic morbidity. Severe hypothermic submersion injuries have complex treatment courses and survivors have variable neurocognitive outcomes. We describe the course of a hypothermic submersion injury in a 6-year-old previously healthy boy. The description includes premorbid and post-injury neurocognitive functioning. A review of the literature of pediatric cold-water submersion injury was performed. Despite prolonged cardiopulmonary resuscitation (>100 min) and water temperature well above freezing, our patient had an optimal neurocognitive outcome following hypothermic submersion injury. Available literature is limited but suggests that increased submersion time, increased duration of resuscitation, and higher water temperatures are associated with worse outcomes. Care guidelines have been created, but outcomes related to these guidelines have not been studied. Our case highlights potential important determinants of outcome after drowning. Incident specific characteristics and therapeutic interventions should be considered when evaluating this population. Treatment guidelines based on currently available literature may fail to incorporate all potential variables, and consideration should be given to prolonged resuscitative efforts based on individual case characteristics until further data is available.
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Affiliation(s)
- Daniel Kriz
- Department of Pediatrics, Division of Psychology, Neuro-Critical Care Program, Oregon Health and Science University, Portland, OR 97239, USA.
- Programs for Evaluation, Development and Learning, St. Charles Healthcare Systems, Bend, OR 97701, USA.
| | - Juan Piantino
- Department of Pediatrics, Division Pediatric Neurology, Neuro-Critical Care Program, Oregon Health and Science University, Portland, OR 97239, USA.
| | - Devin Fields
- Department of Pediatrics, Division of Psychology, Neuro-Critical Care Program, Oregon Health and Science University, Portland, OR 97239, USA.
| | - Cydni Williams
- Department of Pediatrics, Division Pediatric Critical Care, Neuro-Critical Care Program, Oregon Health and Science University, Portland, OR 97239, USA.
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Kumm KR, Galván NTN, Koohmaraie S, Rana A, Kueht M, Baugh K, Hao L, Yoeli D, Cotton R, O'Mahony CA, Goss JA. Are drowned donors marginal donors? A single pediatric center experience. Pediatr Transplant 2017; 21. [PMID: 28670770 DOI: 10.1111/petr.13009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 11/29/2022]
Abstract
Drowning, a common cause of death in the pediatric population, is a potentially large donor pool for OLT. Anecdotally, transplant centers have deemed these organs high risk over concerns for infection and graft dysfunction. We theorized drowned donor liver allografts do not portend worse outcomes and therefore should not be excluded from the donation pool. We reviewed our single-center experience of pediatric OLTs between 1988 and 2015 and identified 33 drowned donor recipients. These OLTs were matched 1:2 to head trauma donor OLTs from our center. A chart review assessed postoperative peak AST and ALT, incidence of HAT, graft and recipient survival. Recipient survival at one year between patients with drowned donor vs head trauma donor allografts was not statistically significant (94% vs 97%, P=.63). HAT incidence was 6.1% in the drowned donor group vs 7.6% in the control group (P=.78). Mean postoperative peak AST and ALT was 683 U/L and 450 U/L for drowned donors vs 1119 U/L and 828 U/L in the matched cohort. These results suggest drowned donor liver allografts do not portend worse outcomes in comparison with those procured from head trauma donors.
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Affiliation(s)
| | - N Thao N Galván
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Sarah Koohmaraie
- Department of Liver Transplantation, Texas Children's Hospital, Houston, TX, USA
| | - Abbas Rana
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Michael Kueht
- Department of Liver Transplantation, Texas Children's Hospital, Houston, TX, USA
| | - Katherine Baugh
- Department of Liver Transplantation, Texas Children's Hospital, Houston, TX, USA
| | - Liu Hao
- Baylor College of Medicine, Houston, TX, USA
| | - Dor Yoeli
- Baylor College of Medicine, Houston, TX, USA
| | - Ronald Cotton
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Christine A O'Mahony
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - John A Goss
- Division of Abdominal Transplantation and Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Surgery, Texas Children's Hospital, Houston, TX, USA
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Williams TM, Zavanelli M, Miller MA, Goldbeck RA, Morledge M, Casper D, Pabst DA, McLellan W, Cantin LP, Kliger DS. Running, swimming and diving modifies neuroprotecting globins in the mammalian brain. Proc Biol Sci 2008; 275:751-8. [PMID: 18089537 DOI: 10.1098/rspb.2007.1484] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The vulnerability of the human brain to injury following just a few minutes of oxygen deprivation with submergence contrasts markedly with diving mammals, such as Weddell seals (Leptonychotes weddellii), which can remain underwater for more than 90 min while exhibiting no neurological or behavioural impairment. This response occurs despite exposure to blood oxygen levels concomitant with human unconsciousness. To determine whether such aquatic lifestyles result in unique adaptations for avoiding ischaemic-hypoxic neural damage, we measured the presence of circulating (haemoglobin) and resident (neuroglobin and cytoglobin) oxygen-carrying globins in the cerebral cortex of 16 mammalian species considered terrestrial, swimming or diving specialists. Here we report a striking difference in globin levels depending on activity lifestyle. A nearly 9.5-fold range in haemoglobin concentration (0.17-1.62 g Hb 100 g brain wet wt(-1)) occurred between terrestrial and deep-diving mammals; a threefold range in resident globins was evident between terrestrial and swimming specialists. Together, these two globin groups provide complementary mechanisms for facilitating oxygen transfer into neural tissues and the potential for protection against reactive oxygen and nitrogen groups. This enables marine mammals to maintain sensory and locomotor neural functions during prolonged submergence, and suggests new avenues for averting oxygen-mediated neural injury in the mammalian brain.
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Affiliation(s)
- Terrie M Williams
- Department of Ecology and Evolutionary Biology, Center for Ocean Health-Long Marine Laboratory, University of California at Santa Cruz, 100 Shaffer Road, Santa Cruz, CA 95060, USA.
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