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The following is a summary of “Factors Associated with Pediatric Drowning-Associated Lung Injury,” published in the December 2024 issue of Pediatrics by Shenoi et al. 

This study aimed to identify the risk factors for clinically important drowning-associated lung injury (ciDALI) in children. A cross-sectional analysis was conducted on pediatric patients aged 0 to 18 years who presented to 32 pediatric emergency departments (EDs) between 2010 and 2017. Data were gathered from emergency medical services, medical records, and fatality records, including demographics, comorbidities, prehospital data, chest radiograph reports, and ED course details. ciDALI was defined by one or more of the following criteria: drowning deaths without cerebral or cervical spine injuries, the need for supplemental oxygen beyond eight hours post-drowning, invasive or non-invasive ventilatory support within the first 24 hours, or abnormal chest radiographs within the first 24 hours that did not resolve within eight hours. A mixed-methods logistic regression analysis with site as a random effect was utilized to identify risk factors, with bootstrapping employed to minimize overfitting.

The study analyzed 4,213 pediatric cases, of which 1,168 (28%) had ciDALI. The median age of patients was 3 years, with an interquartile range of 1 to 5 years. Several significant risk factors for ciDALI were identified: age greater than 5 years (adjusted odds ratio [aOR]: 2.4, 95% CI: 2.0-3.0), submersion for more than 5 minutes (aOR: 6.0, 95% CI: 3.5-10.2), and any resuscitation at the scene (aOR: 3.3, 95% CI: 2.5-4.5). Additional risk factors included abnormal mentation upon ED arrival (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 findings (aOR: 3.9, 95% CI: 2.9-5.4).

The conclusions drawn from this analysis highlight that older age, scene resuscitation, prolonged submersion, and various abnormal clinical findings at ED presentation are significant predictors of ciDALI in pediatric patients. These findings emphasize the need for prospective research to stratify the risk of submersion-related lung injury, which could assist in optimizing short-term outcomes and patient management strategies.

Source: jpeds.com/article/S0022-3476(24)00562-6/abstract