Retrospective evaluation of patients admitted to the emergency department due to drowning

Abstract

Introduction: Drowning is a preventable process that can result in respiratory failure and death, and often occurs accidentally. In this study, it was aimed to evaluate the demographic characteristics and clinical course of the patients admitted to our emergency department in a district neighbouring a lake due to drowning. Methods: Demographic characteristics, time of presentation, swimming ability, accident mechanism, predisposing factors, Glasgow coma scores (GCS), treatment, discharge, hospitalisation decisions, and mortality status of all patients admitted to our emergency department between January 2018 and January 2023 were recorded retrospectively from patient files and the digital automation system. Results: Twenty (66.7%) patients were male and 10 (33.3%) were female; the patients wereaged between 6 months and 59 years, with a mean age of 14.06 years. An analysis of the site of incident revealed that 26 cases (86.6%) drowned in the lake and 4 cases (13.3%) drowned in a water canal. When we analysed the predisposing factors, it was found that one of the cases drowned after an accidental fall while walking on the rocks and one of the cases drowned after having chest pain and syncope. Among the cases with a GCS of 3, 1 of them died in the intensive care unit after 12 hours, 3 of them recovered with tracheostomy sequelae, and the remaining 14 cases died in the emergency department. Mortality was not observed in any of the 12 cases with a GCS of 14 or above. Fourteen cases died in the emergency department, 11 were referred to the intensive care unit, and 5 cases were discharged after emergency department follow-up. When we classified the patients according to Szpilman's clinical classification system, 8 cases were classified as Grade1, 4 cases as Grade 2, 16 cases as Grade 5, and 2 cases as Grade 6. Conclusion: Raising awareness of families with children and increasing the necessary safety measures in water canals in summer months and in lakes is believed to reduce drowning-induced mortality. In addition to preventing drowning cases, providing the public with first aid training for drowning and healthcare professionals with appropriate assessment, intervention, and treatment algorithms may further reduce mortality.

Keywords

• Drowning
• Emergency Department
• Retrospective Evaluation

References

1. van Beeck EF, Branche CM, Szpilman D, Modell JH, Bierens JJ. A new definition of drowning: towards documentation and prevention of a global public health problem. Bull World Health Organ. 2005;83(11):853-6.
2. Forjuoh SN. Water safety and drowning prevention. Int J Inj Contr Saf Promot. 2013;20(3):207-8. https://doi.org/10.1080/17457300.2013.822634
3. Turgut A, Turgut T. A population-based study on deaths by drowning incidents in Turkey. Int J Inj Contr Saf Promot. 2014;21(1):61-7. https://doi.org/10.1080/17457300.2012.759238
4. Demirci Ş, Doğan KH. Types of asphyxia and examination of the dead in asphyxia cases. In: Koc S, Can M, editors. Forensic Medicine in Primary Care. Istanbul: Istanbul Medical Chamber; 2010. p. 38-56.
5. Samprathi M, Agarwal A, Jayashree M, Bansal A, Baranwal A, Nallasamy K, et al. Better groundwork can avoid troubled waters: a developing country perspective on drowning. J Trop Pediatr. 2020;66(4):458-60. https://doi.org/10.1093/tropej/fmz074
6. Peden MM, Kara MG, Krug E, editors. Injury: a leading cause of the global burden of disease, 2000. World Health Organization;2002.
7. Benek S, Özcanlı M. Şanlıurfa İlinde Boğulma Vakalarının İncelenmesi (2001-2008). Marmara Coğrafya Dergisi. 2015;(31):184-203. https://doi.org/10.14781/mcd.00022
8. Levin DL, Morriss FC, Toro LO, Brink LW, Turner GR. Drowning and near-drowning. Pediatr Clin North Am. 1993;40(2):321-36. https://doi.org/10.1016/s0031-3955(16)38513-3

9. Arıca V, Dağ H, Kalçın S, Kök S, Bölük K, Doğan M. Çocuklarda Suda Boğulmalara Güncel Yaklaşımlar. Mustafa Kemal Üniversitesi Tıp Dergisi. 2015;4(15):33-8.
10. Awan B, Wicks S, Peden AE. A qualitative examination of causal factors and parent/caregiver experiences of non-fatal drowning-related hospitalisations of children aged 0–16 years. PLoS one. 2022;17(11): e0276374. https://doi.org/10.1371/ journal-pone.0276374
11. Manglick MP, Ross FI, Waugh MC, Holland AJA, Cass DT, Soundappan SSV. Neurocognitive outcomes in children following immersion: a long-term study. Arch Dis Child. 2018;103(8): 784-89. https://doi.org/10.1136/archdischild-2017-314051
12. Szpilman D. Near-drowning and drowning classification: A proposal to stratify mortality based on the analysis of 1,831 cases. Chest. 1997;112(3):660-5. https://doi.org/10.1378/chest.112.3.660
13. Başol N, Baydın A, Yardan T. Acil servise boğulma nedeniyle başvuran hastaların geriye dönük incelenmesi. J Exp Clin Med. 2012;29:121-25. https://doi.org/10.5835/jecm.omu.29.02.008
14. Fang Y, Dai L, Jaung MS, Chen X, Yu S, Xiang H. Child drowning deaths in Xiamen city and suburbs, People's Republic of China, 2001-5. Inj Prev. 2007;13(5):339-43. https://doi.org/10.1136/ip.2007.016683
15. Sheikhazadi A, Ghadyani MH. Epidemiology of drowning in Isfahan province, center of Iran. J Res Med Sci. 2009;14(2):79–87.
16. Tıraşçı Y, Gören S. Evaluation of drowning cases in Diyarbakır. Dicle Med J. 2000;27(1):139-44.
17. Morgenstern H, Bingham T, Reza A. Effects of pool-fencing ordinances and other factors on childhood drowning in Los Angeles County, 1990-1995. Am J Public Health. 2000;90(4):595-601. https://doi.org/10.2105/ajph.90.4.595
18. Joseph MM, King WD. Epidemiology of hospitalization for near-drowning. South Med J. 1998;91(3):253-5. https://doi.org/10.1097/00007611-199803000-00007
19. Arslan MM, Kar H, Akcan R, Çekin N. Examination of the methods used in the diagnosis of drowning in water. Bull Leg Med.2005;10(1):29-34. https://doi.org/10.17986/blm.2005101574
20. Cantürk N, Cantürk G, Karbeyaz K, Özdeş T, Dağalp R, Çelik S. Evaluation of the deaths due to drowning autopsied between 2003 and 2006 in Ankara. Türkiye Klinikleri Journal of Med Sci. 2009;29(5):1198-205.
21. Saunders CJ, Adriaanse R, Simons A, van Niekerk A. Fatal drowning in the Western Cape, South Africa: a 7-year retrospective, epidemiological study. Inj Prev. 2019;25(6):529-34. https://doi.org/10.1136/injuryprev-2018-042945
22. Ballesteros MF, Schieber RA, Gilchrist J, Holmgreen P, Annest JL. Differential ranking of causes of fatal versus non-fatal injuries among US children. Inj Prev. 2003;9(2):173-6. https://doi.org/10.1136/ip.9.2.173
23. Söyüncü S, Işık S, Bektaş F, Yiğit Ö. The validity of Glasgow Coma Scale and Rapid Emergency Medicine score in evaluating patients admitted to the emergency department with drowning or near-drowning. Turk J Emerg Med. 2008;8(2):67-72.
24. Brüning C, Siekmeyer W, Siekmeyer M, Merkenschlager A, Kiess W. Retrospective analysis of 44 childhood drowning accidents. Wien Klin Wochenschr. 2010;122(13-14):405-12. https://doi.org/10.1007/s00508-010-1400-7
25. Son KL, Hwang SK, Choi HJ. Clinical features and prognostic factors in drowning children: a regional experience. Korean J Pediatr. 2016;59(5):212-17. https://doi.org/10.3345/kjp.2016.59.5.212