Submersion injuries in the United States: Patients characteristics and predictors of mortality and morbidity

Abstract

Introduction: Drowning leads to 372,000 deaths annually worldwide and to severe morbidity secondary to asphyxiation or aspiration. Previous studies described submersion injuries mainly in the pediatric population. This study describes characteristics of patients presenting with submersion injuries to United States emergency departments (EDs) and identifies predictors of poor outcomes (death or long term neurologic deficits) after drowning.

Methods: This retrospective cross-sectional study included ED visits for submersion injuries from the United States 2013 Nationwide Emergency Department Sample (NEDS) dataset using discharge data (CCS diagnosis codes). Descriptive analysis was done for the collected variables and was followed by a multivariate regression analysis to identify predictors of poor outcomes (mortality and morbidity).

Results: A total of 12,529 weighted patients presented to EDs for submersion injury in 2013 yielding a rate of 9.29 per 100,000 ED visits. Patients were more frequently males (65.8%, 95%CI: 64.0-67.6) and in the 19-65 years age group (41.8%, 95%CI: 40.0-43.6). Poor outcomes were present in 11.7% (95%CI: 10.5-13.0) of patients. Significant positive predictors of poor outcomes were: male gender (OR = 1.761, 95%CI: 1.247-2.487); presence of chronic conditions involving infectious and parasitic disease (OR = 2.824, 95%CI: 1.155-6.908), the circulatory system (OR = 12.818, 95%CI: 8.953-18.351), the respiratory system (OR = 1.498, 95%CI: 1.079-2.079) or the digestive system (OR = 2.006, 95%CI: 1.106-3.636); associated motor vehicle traffic injury (OR = 5.221, 95%CI: 1.563-17.441) and self-payers.

Conclusion: Submersion remains a high impact emergency condition in the United States. Significant predictors of poor outcomes were identified. Prevention efforts targeting susceptible population are needed to reduce the impact of submersion injuries on different communities in the United States.

Keywords: Dataset; Drowning; Emergency department; Epidemiology; Injury; National emergency department sample (NEDS); Outcomes; Submersion.