Factors Associated with Pediatric Drowning-Associated Lung Injury

Rohit P Shenoi; James E Crowe; Scott R Dorfman; Kelly R Bergmann; Rakesh D Mistry; Selena Hariharan; Melissa M Tavarez; Shannon Wai; Jennifer L Jones; Melissa L Langhan; Caleb E Ward; Tracy E McCallin; Usha Sethuraman; Nipam Shah; Donna Mendez; Katherine H Wolpert; Claritsa Santos-Malave; Timothy Ruttan; Kimberly S Quayle; Pamela Okada; Beth Bubolz; James F Buscher; Ryan McKee; Karen Mangold; Wendi-Jo Wendt; Amy D Thompson; Jeffrey Hom; Anne F Brayer; Mercedes M Blackstone; Courtney Brennan; W Scott Russell; Maneesha Agarwal; Kajal Khanna; Jeff Louie; David Sheridan; Elizabeth A Camp; Pediatric Emergency Medicine Collaborative Research Committee

doi:10.1016/j.jpeds.2024.114459

Factors Associated with Pediatric Drowning-Associated Lung Injury

J Pediatr. 2024 Dec 28:114459. doi: 10.1016/j.jpeds.2024.114459. Online ahead of print.

Authors

Rohit P Shenoi¹, James E Crowe², Scott R Dorfman², Kelly R Bergmann³, Rakesh D Mistry⁴, Selena Hariharan⁵, Melissa M Tavarez⁶, Shannon Wai⁷, Jennifer L Jones⁸, Melissa L Langhan⁹, Caleb E Ward¹⁰, Tracy E McCallin¹¹, Usha Sethuraman¹², Nipam Shah¹³, Donna Mendez¹⁴, Katherine H Wolpert¹⁵, Claritsa Santos-Malave¹⁶, Timothy Ruttan¹⁷, Kimberly S Quayle¹⁸, Pamela Okada¹⁹, Beth Bubolz²⁰, James F Buscher²¹, Ryan McKee²², Karen Mangold²³, Wendi-Jo Wendt²⁴, Amy D Thompson²⁵, Jeffrey Hom²⁶, Anne F Brayer²⁷, Mercedes M Blackstone²⁸, Courtney Brennan²⁹, W Scott Russell³⁰, Maneesha Agarwal³¹, Kajal Khanna³², Jeff Louie³³, David Sheridan³⁴, Elizabeth A Camp³⁵; Pediatric Emergency Medicine Collaborative Research Committee

Affiliations

¹ Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA. Electronic address: [email protected].
² Department of Radiology, Texas Children's Hospital, Houston, TX.
³ Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN, USA.
⁴ (new) Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; (old) Department of Pediatrics, Section of Emergency Medicine, Children's Hospital Colorado, Denver, CO, USA.
⁵ Department of Pediatrics, Division of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
⁶ Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁷ (new) Mary Bridge Children's Hospital, Department of Pediatrics, University of Washington, WA, USA; (old) Department of Emergency Medicine, Rady Children's Hospital, San Diego, CA, USA.
⁸ Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA; (old) Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
⁹ Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
¹⁰ Division of Emergency Medicine, Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC. USA.
¹¹ (new) Division of Pediatric Emergency Medicine, UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA; (old) Department of Pediatrics, Children's Hospital of San Antonio, San Antonio, TX, USA.
¹² Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Michigan/Central Michigan University, Detroit, MI, USA.
¹³ Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁴ (New) Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, TX, USA; (Old) Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
¹⁵ (new) Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; (old) Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Utah, Primary Children's Hospital in Salt Lake, Salt Lake City, UT, USA.
¹⁶ Division of Pediatric Emergency Medicine, Joe DiMaggio Children's Hospital, Hollywood, FL, USA.
¹⁷ Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA, US Acute Care Solutions, Canton, OH. USA.
¹⁸ Department of Pediatrics, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
¹⁹ Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA.
²⁰ Department of Pediatrics, Section of Emergency Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.
²¹ (new) Division of Emergency Medicine, Department of Pediatrics, University of Nebraska Medical Center; (old) Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, FL, USA.
²² Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma City, OK, USA.
²³ Department of Pediatrics (Emergency Medicine), Feinberg School of Medicine, Northwestern University; Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.
²⁴ (new) Division of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA; (old) Department of Emergency Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, MI, USA.
²⁵ Division of Emergency Medicine, Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, DE, USA.
²⁶ Departments of Pediatrics and Emergency Medicine, Stony Brook University, New York, NY, USA.
²⁷ Department of Pediatrics and Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA.
²⁸ Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
²⁹ Division of Emergency and Transport Medicine, Children's Hospital of Los Angeles, Keck School of Medicine/University of Southern California, Los Angeles, CA, USA.
³⁰ Department of Pediatrics, Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA.
³¹ Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.
³² Department of Emergency Medicine, Stanford University, Stanford, CA, USA.
³³ Department of Pediatrics, Division of Emergency Medicine, University of Minnesota Masonic Children's Hospital, MN, USA.
³⁴ Department of Emergency Medicine/Pediatrics, Oregon Health & Science University, Portland, OR, USA.
³⁵ Division of Emergency Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.

PMID: 39736377
DOI: 10.1016/j.jpeds.2024.114459

Abstract

Objective: To identify risk factors for clinically-important drowning-associated lung injury (ciDALI) in children.

Study design: 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.

Results: 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]).

Conclusions: 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.

Keywords: Drowning; Lung Injury; Outcomes.