Prehospital and Resuscitation Factors Associated With Favorable Pediatric Drowning Outcomes

Objectives: Drowning is a leading cause of unintentional injury death in children in the United States. There is a need to identify prehospital factors that affect drowning outcomes. We sought to study prehospital and resuscitation factors associated with favorable neurological outcomes at hospital discharge among pediatric drowning patients. Methods: This was a retrospective study of drowning patients younger than 18 years in an urban area from 2010 to 2017. Submersion, prehospital, and patient data were obtained from hospital, Emergency Medical Services, and fatality records. The outcome was classified as favorable or poor neurological status at hospital discharge based on the Cerebral Performance Category (CPC). Logistic regression determined prehospital predictors associated with favorable outcomes. Results: There were 803 submersions; outcomes were available in 759 (94.5%) cases. The median age was 3 years (IQR: 2, 5), and 60% were males. Eighty-four percent of patients had favorable neurological outcomes at hospital discharge. Bivariate analysis revealed that age <5 years, drowning in constructed bodies of water, witnessed drownings, supervisor present, submersions of 0 to 5 minutes duration, non-Emergency Medical Services transport, or absence of bystander cardiopulmonary resuscitation (BCPR) were associated with favorable outcomes. Predictive factors for favorable outcomes included supervisor presence, drowning in constructed bodies of water, submersion of 0 to 5 minutes, or no BCPR. Patients in cardiac arrest who attained return of spontaneous circulation at the emergency department arrival had higher odds of a favorable outcome than patients who did not attain a return of spontaneous circulation [OR: 6.6 (95% CI: 1.9-28.3)]. No association between bystander resuscitation and favorable outcomes in patients in cardiac arrest due to drowning [OR: 2.98 (95% CI: 0.31-145.81)] was observed. Conclusions: In an urban area, pediatric drowning patients who have a supervisor present, with brief submersion times, and who drown in constructed bodies of water are more likely to experience favorable neurological outcomes at hospital discharge. No association between BCPR and favorable pediatric drowning outcomes was observed.