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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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Bellini T, Baffi S, Brisca G, Calevo MG, Franzone D, Misley S, D'Alessandro M, Piccotti E, Moscatelli A. Individual, environmental and demographic factors may play a role in the prognosis of fatal and non-fatal paediatric drowning. Acta Paediatr 2023. [PMID: 37888497 DOI: 10.1111/apa.17016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/11/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023]
Abstract
AIM Drowning is a leading cause of unintentional death. Ongoing efforts are dedicated to preventing these tragic incidents. Our aim was to evaluate whether demographic, environmental and epidemiological characteristics of drowned children influence their prognosis. METHODS Single-centre retrospective study spanning 12 years. Each patient's record included: age, sex, place of residence, presence of siblings, season of incident, location of event, associated trauma, loss of consciousness, need for cardiopulmonary resuscitation, intubation, admission to intensive care unit, length of stay and mortality. RESULTS We enrolled 60 patients, with a mean age of 5.9 ± 3.4 years; 63.5% were male. Children who did not reside near the sea were significantly older than those who did (p = 0.01) and faced a higher risk of experiencing sea-related drowning (p = 0.05). No patients died. Loss of consciousness and need for cardiopulmonary resuscitation were recorded in 30 and 19 patients respectively. Seven patients sustained trauma. Only one patient requiring intubation. Pool-related drowning were associated with a higher incidence of needing cardiopulmonary resuscitation (p = 0.02). The need for cardiopulmonary resuscitation (p = 0.05) and the occurrence of trauma (p = 0.02) were identified as risk factors for a longer hospitalisation. CONCLUSION Prevention and early initiation of cardiopulmonary resuscitation are essential for achieving a favourable prognosis. Identifying demographic and environmental risk factors may help identify other effective preventive measures.
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Affiliation(s)
- Tommaso Bellini
- Paediatric Emergency Room and Emergency Medicine Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Susanna Baffi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Giacomo Brisca
- Paediatric and Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daniele Franzone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Silvia Misley
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matteo D'Alessandro
- Paediatric Emergency Room and Emergency Medicine Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Emanuela Piccotti
- Paediatric Emergency Room and Emergency Medicine Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Moscatelli
- Paediatric and Neonatal Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Peri F, De Nardi L, Canuto A, Gaiero A, Noli S, Ferretti M, Vergine G, Falcioni A, Copponi E, Tagliabue B, Massart F, Fabiani E, Stringhi C, Rubini M, Zamagni G, Amaddeo A, Genovese MR, Norbedo S. Drowning in Children and Predictive Parameters: A 15-Year Multicenter Retrospective Analysis. Pediatr Emerg Care 2023; 39:516-523. [PMID: 37335544 DOI: 10.1097/pec.0000000000002987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Drowning is a serious and underestimated public health problem, with the highest morbidity and mortality reported among children. Data regarding pediatric outcomes of drowning are often inadequate, and data collection is poorly standardized among centers. This study aims to provide an overview of a drowning pediatric population in pediatric emergency department, focusing on its main characteristics and management and evaluating prognostic factors. METHODS This is a retrospective multicenter study involving eight Italian Pediatric Emergency Departments. Data about patients between 0 to 16 years of age who drowned between 2006 and 2021 were collected and analyzed according to the Utstein-style guidelines for drowning. RESULTS One hundred thirty-five patients (60.9% males, median age at the event 5; interquartile range, 3-10) were recruited and only those with known outcome were retained for the analysis (133). Nearly 10% had a preexisting medical conditions with epilepsy being the most common comorbidity. One third were hospitalized in the intensive care unit (ICU) and younger males had a higher rate of ICU admission than female peers. Thirty-five patients (26.3%) were hospitalized in a medical ward while 19 (14.3%) were discharged from the emergency department and 11 (8.3%) were discharged after a brief medical observation less than 24 hours. Six patients died (4.5%). Medium stay in the ED was approximately 40 hours. No difference in terms of ICU admission was found between cardiopulmonary resuscitation performed by bystanders or trained medical personnel ( P = 0.388 vs 0.390). CONCLUSIONS This study offers several perspectives on ED victims who drowned. One of the major finding is that no difference in outcomes was seen in patients who received cardiopulmonary resuscitation performed by bystanders or medical services, highlighting the importance of a prompt intervention.
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Affiliation(s)
- Francesca Peri
- From the Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Laura De Nardi
- From the Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Arianna Canuto
- From the Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Alberto Gaiero
- Pediatric and Neonatology Unit, Ospedale San Paolo Savona, Savona, Italy
| | - Serena Noli
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini Institute, University of Genova, Genova, Italy
| | - Marta Ferretti
- Department of Pediatrics, IRCCS Istituto Giannina Gaslini Institute, University of Genova, Genova, Italy
| | - Gianluca Vergine
- Department of Pediatrics, Infermi Hospital Rimini, ASL Romagna, Italy
| | - Alice Falcioni
- Department of Pediatrics, Infermi Hospital Rimini, ASL Romagna, Italy
| | | | - Bruna Tagliabue
- Department of Pediatrics, University of Brescia, Brescia, Italy
| | - Francesco Massart
- Pediatric Unit, Maternal and Infant Department, Santa Chiara's University Hospital of Pisa, Pisa, Italy
| | - Elisabetta Fabiani
- Department of Pediatric Emergency, Gaspare Salesi Hospital, Azienda Ospedaliera Ospedali Riuniti, Ancona, Italy
| | | | - Monica Rubini
- Department of Pediatric Emergency, Parma Children's Hospital, Parma, Italy
| | - Giulia Zamagni
- Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Maria Rita Genovese
- From the Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Stefania Norbedo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Pellegrino F, Raffaldi I, Rossi R, De Vito B, Pagano M, Garelli D, Bondone C. Epidemiology, clinical aspects, and management of pediatric drowning. Ital J Pediatr 2023; 49:74. [PMID: 37316902 PMCID: PMC10268379 DOI: 10.1186/s13052-023-01464-1] [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: 02/06/2023] [Accepted: 04/28/2023] [Indexed: 06/16/2023] Open
Abstract
Drowning is the third leading cause of injury death in the pediatric population worldwide, with incidence peaking among those aged 1-4 years and again in adolescence.The purpose of this commentary is to review the basic pathophysiology of drowninginjury and factors that affect the outcome, such as submersion and hypothermia. We also discuss principles of prehospital and in-hospital management, comprising resuscitation and stabilization, administration of oxygen and intravenous liquids, and central reheating.Even though the mortality rate has decreased in recent years, further investments and safety measures are needed to prevent child drowning deaths.
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Affiliation(s)
- Francesco Pellegrino
- Department of Pediatric and Public Health Sciences, Postgraduate School of Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy.
| | - Irene Raffaldi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Roberta Rossi
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Barbara De Vito
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Manuela Pagano
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Davide Garelli
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Claudia Bondone
- Department of Pediatric Emergency, Regina Margherita Children's Hospital - A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
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Camara C, Watson C. Hypothermia and cold injuries in children and young people. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:776-779. [PMID: 35980920 DOI: 10.12968/bjon.2022.31.15.776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although hypothermia and cold injuries are rare in children and young people in the UK, the risk is persistent and requires urgent medical management when it does occur. This article outlines some considerations for professionals who may be caring for hypothermic patients or those at risk of becoming hypothermic.
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Affiliation(s)
| | - Chloe Watson
- Staff Nurse, Royal Victoria Infirmary, Newcastle upon Tyne
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A Smart Multi-Sensor Device to Detect Distress in Swimmers. SENSORS 2022; 22:s22031059. [PMID: 35161813 PMCID: PMC8839118 DOI: 10.3390/s22031059] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 01/18/2023]
Abstract
Drowning is considered amongst the top 10 causes of unintentional death, according to the World Health Organization (WHO). Therefore, anti-drowning systems that can save lives by preventing and detecting drowning are much needed. This paper proposes a robust and waterproof sensor-based device to detect distress in swimmers at varying depths and different types of water environments. The proposed device comprises four main components, including heart rate, blood oxygen level, movement, and depth sensors. Although these sensors were designed to work together to boost the system’s capability as an anti-drowning device, each could operate independently. The sensors were able to determine the heart rate to an accuracy of 1 beat per minute (BPM), 1% SpO2, the acceleration with adjustable sensitivities of ±2 g, ±4 g, ±8 g, and ±16 g, and the depth up to 12.8 m. The data obtained from the sensors were sent to a microcontroller that compared the input data to adjustable threshold values to detect dangerous situations. Being in hazardous situations for more than a specific time activated the alarming system. Based on the comparison made in the program and measuring the time of submersion, a message indicating drowning or safe was sent to a lifeguard to continuously monitor the swimmer’ condition via Wi-Fi to an IP address reachable by a mobile phone or laptop. It is also possible to continuously monitor the sensor outputs on the device’s display or the connected mobile phone or laptop. The threshold values could be adjusted based on biometric parameters such as swimming conditions (swimming pool, beach, depth, etc.) and swimmers health and conditions. The functionality of the proposed device was thoroughly tested over a wide range of parameters and under different conditions, both in air and underwater. It was demonstrated that the device could detect a range of potentially hazardous aquatic situations. This work will pave the way for developing an effective drowning sensing system that could save tens of thousands of lives across the globe every year.
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