Factors Associated with Pediatric Drowning-Associated Lung Injury

• Published in: The Journal of pediatrics 2024-12, p.114459, Article 114459
• Main Authors: Shenoi, Rohit P., Crowe, James E., Dorfman, Scott R., Bergmann, Kelly R., Mistry, Rakesh D., Hariharan, Selena, Tavarez, Melissa M., Wai, Shannon, Jones, Jennifer L., Langhan, Melissa L., Ward, Caleb E., McCallin, Tracy E., Sethuraman, Usha, Shah, Nipam, Mendez, Donna, Wolpert, Katherine H., Santos-Malave, Claritsa, Ruttan, Timothy, Quayle, Kimberly S., Okada, Pamela, Bubolz, Beth, Buscher, James F., McKee, Ryan, Mangold, Karen, Wendt, Wendi-Jo, Thompson, Amy D., Hom, Jeffrey, Brayer, Anne F., Blackstone, Mercedes M., Brennan, Courtney, Russell, W. Scott, Agarwal, Maneesha, Khanna, Kajal, Louie, Jeff, Sheridan, David, Camp, Elizabeth A.
• Format: Article
• Language: English
• Subjects: Drowning; Lung Injury; Outcomes
• ISSN: 0022-3476; 1097-6833; 1097-6833
• DOI: 10.1016/j.jpeds.2024.114459

To identify risk factors for clinically-important drowning-associated lung injury (ciDALI) in children. This was a cross-sectional study of children (0 through18 years) who presented to 32 pediatric emergency departments (EDs) from 2010 through 2017. We reviewed demographics, comorbidities, prehospital data, chest radiographs reports, and ED course from emergency medical services, medical, and fatality records. We defined ciDALI as presence of any: 1) drowning deaths without cerebral/cervical spine injuries; 2) supplemental oxygen >8 hours post-drowning; 3) invasive/non-invasive ventilatory support in first 24 hours; or 4) abnormal chest radiographic findings in the first 24 hours without resolution within 8 hours post-drowning. We used mixed-methods logistic regression with site as random effect to identify risk factors and bootstrapping to reduce overfitting. We enrolled 4,213 patients (no ciDALI=3,045 [72%]; ciDALI=1,168 [28%]). The median age was 3 years (IQR:1,5). The risk factors for patients with ciDALI were age >5 years old (aOR:2.4 [95%CI: 2.0-3.0]); submersion >5 minutes (aOR:6.0 [95%CI: 3.5-10.2]); any scene resuscitation (aOR:3.3 [95%CI: 2.5-4.5]) and at presentation to the ED abnormal mentation (aOR:6.4 [95%CI: 4.1-10.0)]), abnormal heart rate (aOR:1.8 [95%CI: 1.6-2.1])], abnormal respiratory rate (aOR:1.8 [95%CI: 1.4-2.3]), hypotension (aOR:2.8 [95%CI: 1.0-7.4]), and abnormal lung auscultation (OR:3.9 [95%CI: 2.9-5.4]). Pediatric ciDALI risk factors include older age, scene resuscitation, prolonged submersion, and abnormal pulmonary, hemodynamic, and neurological findings at ED presentation. Prospective research to stratify risks based on submersion-related lung injury is needed to help determine short-term outcome and optimize patient disposition.