[Retrospective analysis of 44 childhood drowning accidents]

Abstract

Background: Worldwide, drowning is the second leading cause of unintentional death and the leading cause of cardiovascular failure for children [1-3]. The number of near-drownings, where the incident is survived for at least 24 hours, is assumed to be four times as high [5]. In the years 1994 until 2008 there were 44 cases of drowning treated at the children's department of the University of Leipzig. This number shows that even in a medical centre drowning incidents are only occasional incidents. Therefore it is important to know the sequelae and handlings to be able to react in case of an emergency.

Patients: A total of 44 children suffering a drowning accident within the last 48 hours who were treated during the period of 01.01.1994 through 30.06.2008 at the Children's Centre at the University of Leipzig.

Methods: A retrospective analysis using a structured questionnaire was done. Social demographic data, accident progress, clinical results and progress as well as outcome of the cases were investigated.

Results: During the analysed period in the median three children were treated each year after drowning incidents. Clustering in the summer and winter months and on the weekends was recognizable. The median age was 3.33 years and the group of high risk were children aged 1-3 years, especially boys. Sixty percent of the children came from stable social backgrounds. Half of the children suffered from drowning in created swimming pools or ponds, the rest in natural waters, public pools and sources of water in the household. The median submersion lasted 2 minutes. Correlation of submersions below 1 minute with a good, and submersions above 10 minutes with a negative outcome was shown. A Glasgow Coma Scale (GCS) of 3 points (n = 15) and pupils without light reaction (n = 14) were associated with a lethal outcome or residual neurological deficits. Looking at the laboratory values, correlation between severe acidotic pH-values with a very low base excess, high blood sugar as well as high lactate values and a poor outcome is revealed. Six patients died within the first 24 hours, 6 more over the course suffering organ failure or brain death. Five children retained neurological damages. Twenty-seven children could be released from the clinic healthily.

Conclusion: The risk of suffering a drowning incident is highest for boys aged 1-3 years, playing in the yard by themselves. Prognosis is depending on multiple factors and especially the circumstances of the accident. High influence is seen in the time of submersion and the need for cardiopulmonary resuscitation. Clinics and laboratory values at the time of hospital admittance may hint to the outcome. Basic life support at the scene of the accident has the highest impact on the outcome. Training of parents and supervisors in prevention and first aid after drowning incidents can avoid accidents.