Epidemiology and clinical characteristics of drowning patients presenting to a pediatric emergency department from 2017 to 2020.

BACKGROUND: Drowning is a common mechanism of injury in the pediatric population that often requires hospitalization. The primary objective of this study was to describe the epidemiology and clinical characteristics of pediatric drowning patients evaluated in a pediatric emergency department (PED), including the clinical interventions and outcomes of this patient population. METHODS: A retrospective cohort study was conducted of pediatric patients evaluated in a mid-Atlantic urban pediatric emergency department from January 2017 to December 2020 after a drowning event. RESULTS: Eighty patients ages 0-18 were identified, representing 57 79 unintentional events and 1 intentional self-injury event. The majority of patients (50%) were 1-4 years of age. The majority (65%) of patients 4 years of age or younger were White, whereas racial/ethnic minority patients accounted for the majority (73%) of patients 5 years of age or older. Most drowning events (74%) occurred in a pool, on Friday through Saturday (66%) and during the summer (73%). Oxygen was used in 54% of admitted patients and only in 9% of discharged patients. Cardiopulmonary resuscitation (CPR) was performed in 74% of admitted patients and 33% of discharged patients. CONCLUSIONS: Drowning can be an intentional or unintentional source of injury in pediatric patients. Among the patients who presented to the emergency department for drowning, more than half received CPR and/or were admitted, suggesting high acuity and severity of these events. In this study population, outdoor pools, summer season and weekends are potential high yield targets for drowning prevention efforts.

Epidemiology of paediatric injuries in Nepal: evidence from emergency department injury surveillance.

BACKGROUND: Globally, injuries cause >5 million deaths annually and children and young people are particularly vulnerable. Injuries are the leading cause of death in people aged 5-24 years and a leading cause of disability. In most low-income and middle-income countries where the majority of global child injury burden occurs, systems for routinely collecting injury data are limited. METHODS: A new model of injury surveillance for use in emergency departments in Nepal was designed and piloted. Data from patients presenting with injuries were collected prospectively over 12 months and used to describe the epidemiology of paediatric injury presentations. RESULTS: The total number of children <18 years of age presenting with injury was 2696, representing 27% of all patients presenting with injuries enrolled. Most injuries in children presenting to the emergency departments in this study were unintentional and over half of children were <10 years of age. Falls, animal bites/stings and road traffic injuries accounted for nearly 75% of all injuries with poisonings, burns and drownings presenting proportionately less often. Over half of injuries were cuts, bites and open wounds. In-hospital child mortality from injury was 1%. CONCLUSION: Injuries affecting children in Nepal represent a significant burden. The data on injuries observed from falls, road traffic injuries and injuries related to animals suggest potential areas for injury prevention. This is the biggest prospective injury surveillance study in Nepal in recent years and supports the case for using injury surveillance to monitor child morbidity and mortality through improved data.

When Natural Hazards Intersect with Public Health: A Preliminary Exploration of the Impact of Bushfires and the COVID-19 Pandemic on Australian Coastal Drowning Fatalities.

Natural hazards combined with the COVID-19 pandemic have had significant global impacts to the community and the environment. This study explores the impact of the Australian 2019/20 bushfires followed by the COVID-19 pandemic on unintentional coastal drowning fatalities. Fatality data were collated using triangulation methodology. Percentage change in coastal drowning fatalities between 2019/20 financial year (FY) and the 15FY annual average (2004/5-2018/19) were calculated for the dominant bushfire period (August 2019-February 2020 inclusive) and COVID-19 restrictions in place for 2019/20FY (March-June 2020 inclusive). Relative risk (RR; with 95% confidence intervals [CI]) of coastal drowning was calculated against the average for overall, bushfire and COVID-19 periods, using coastal participation data as the denominator, weighted for the predicted decrease in the use of outdoor coastal areas due to these widespread events. Coastal drowning fatalities increased in 2019/20FY by 9% overall (bushfires: 6%; COVID-19: 9%). Swimming/wading drowning fatalities increased during the bushfire period (RR = 2.02; 95% CI: 1.13-3.63), while boating and personal watercraft (PWC)-related fatalities increased during both the bushfire (RR = 2.92; 95% CI: 1.41-6.05) and COVID-19 period (RR = 3.86; 95% CI: 1.64-9.11). Rock fishing fatalities also increased across both the bushfire (RR = 4.19; 95% CI: 1.45-12.07; p = 0.008) and COVID-19 (RR = 3.8;95% CI: 1.24-11.62; p = 0.027) periods. Findings indicate the activity patterns leading to coastal drowning fatalities changed despite significant public health events impacting freedom of movement and thus opportunity for coastal participation. Understanding, and preparing for, the impacts of natural hazards on drowning risk is vital for future preventive efforts.