Childhood Drowning: Review of Patients Presenting to the Emergency Departments of 2 Large Tertiary Care Pediatric Hospitals Near and Distant From the Sea Coast

National trends in pediatric drowning - insights from the Israeli Ministry of Health registry-based cohort

This study analyzes the epidemiology of pediatric drowning in Israel from 2010 to 2022, focusing on differences across age groups, sex, and regions. We conducted a retrospective cohort study using data from the Ministry of Health's administrative databases, covering all children aged 0-17 years who were seen in the emergency department, discharged after hospitalization, or died at the scene due to drowning, excluding cases of intentional harm or suicide. The primary outcome was the annual drowning rate per 100,000 children, categorized by age, sex, and region, along with hospitalization duration, intensive care unit admissions, and mortality rates. A total of 2101 drowning incidents were identified, with 9% resulting in death. Higher drowning rates were found in younger children (1-4 years) and teenagers (15-17 years), with notable differences by sex. Drowning rates were higher in coastal regions and more frequent during winter and spring. An increase in drowning rates was observed over the last 3 years of the study (2020-2022). Children hospitalized for more than 3 days had significantly higher mortality rates, both in general wards and intensive care units.

CONCLUSIONS

Pediatric drowning is a persistent public health concern in Israel, with distinct seasonal, regional, age-specific, and sex-specific patterns in incidence and mortality. This study underscores the need for a comprehensive prevention strategy that includes year-round public education, environmental safety measures, and targeted interventions for high-risk groups to reduce drowning incidents and fatalities among children effectively.

WHAT IS KNOWN

• Pediatric drowning represents a significant public health challenge globally, with varying rates. • In Israel, pediatric drowning is the second leading cause of death from all injury-related deaths. Thus far, the measures and interventions to reduce fatalities were not proven effective enough.

WHAT IS NEW

• Pediatric drowning in Israel, with a 9% mortality rate, revealed a biphasic rate varied by sex and is higher in coastal regions and during winter and spring. • There was a notable increase in drowning incidents during the last 3 years of the study period (2020-2022), coinciding with the COVID-19 pandemic.

Observing Patterns of River Usage

Rivers are a leading location for drowning, yet little is known about people’s usage of these waterways. This pilot study aimed to test the use of direct observations to calculate river usage. Direct observations were conducted at regular intervals within defined zones at four river drowning locations in Australia (including weekends and the Australia Day national public holiday). Data recorded were date and time of observation; total people (including males, females, children, and adults); and number of people on, in, and beside the water. Univariate analysis with mean (SD) and range was conducted. Interrater reliability for observations was determined using the intraclass correlation coefficient (ICC) (one-way random-effects, average measures model), with a 95% confidence interval (CI). Across 149 time points, 309 observations resulted in 13,326 river interactions observed by multiple observers. There was an average of 39 people (M = 39.4, SD = 29.4, range = 0–137) per observation, 44 people (M = 44.2, SD = 32.7, range = 0–37) on an average weekend, and 97 people (M = 96.8, SD = 58.1, range = 20–190) on Australia Day. More females (M = 20.6, SD = 16.0, range = 0–83) than males (M = 18.3, SD = 14.5, range = 0–68) were observed. More people were observed in the water (M = 20.6, SD = 20.4, range = 0–84) than beside or on the water. Interrater reliability was excellent, consistently above 0.900 for all variables collected (apart from the variable of beside the river). Despite males accounting for 80% of river drowning fatalities, more females were observed than males. Increased visitation on the Australia Day public holiday may be linked to increased drowning risk. This study detailed a simple approach to data collection, exploring exposure within a defined zone at river locations. River usage is dynamic, with people’s movement in and out of the water changing their risk exposure. Observational-based data collection for drowning, particularly for rivers, is an important yet highly neglected area of research.

Cardiac Arrest in Special Circumstances-Recent Advances in Resuscitation

BACKGROUND

Cardiopulmonary resuscitation (CPR) in special circumstances includes the emergency intervention for special causes, special environments, and special patients. Special causes cover the potential reversible causes of cardiac arrest that must be identified or excluded during any resuscitation act. The special environments section includes recommendations for the treatment of cardiac arrest occurring in specific locations: cardiac surgery, catheterization laboratory, dialysis unit, dental surgery, commercial airplanes or air ambulances, playing field, difficult environment (eg, drowning, high altitude, avalanche, and electrical injuries) or mass casualty incident. CPR for special patients gives guidance for the patients with severe comorbidities (asthma, heart failure with ventricular assist devices, neurological disease, and obesity) and pregnant women or older people.

AREAS OF UNCERTAINTY

There are no generally worldwide accepted resuscitation guidelines for special circumstance, and there are still few studies investigating the safety and outcome of cardiac arrest in special circumstances. Applying standard advanced life support (ALS) guidelines in this situation is not enough to obtain better results from CPR, for example, cardiac arrest caused by electrolyte abnormalities require also the treatment of that electrolyte disturbance, not only standard CPR, or in the case of severe hypothermia, when standard ALS approach is not recommended until a temperature threshold is reached after warming measures. Data sources for this article are scientific articles describing retrospective studies conducted in CPR performed in special circumstances, experts' consensus, and related published opinion of experts in CPR.

THERAPEUTIC ADVANCES

The newest advance in therapeutics applied to resuscitation field for these particular situations is the use of extracorporeal life support/extracorporeal membrane oxygenation devices during CPR.

CONCLUSIONS

In special circumstances, ALS guidelines require modification and special attention for causes, environment, and patient particularities, with specific therapeutic intervention concomitant with standard ALS.