Ahogamientos por inmersión no intencional. Análisis de las circunstancias y perfil epidemiológico de las víctimas atendidas en 21 servicios de urgencias españoles

Abstract

ObjectivesTo determine the frequency of accidental drowning seen in paediatric emergency departments, to define the epidemiological profile of the victims, and to analyse the circumstances related to prognosis and survival. Patients and methodsA multicentre, prospective and descriptive study was conducted on victims of accidental drowning seen in 21 paediatric emergency departments between June and September 2009 and 2010. We collected personal, environmental, safety, security data, as well as the need for cardiopulmonary resuscitation (CPR), hospitalisation rate, sequelae and mortality. ResultsOut of 234,566 emergency department cases, 53 were due to accidental drowning (frequency: 2.2/10,000 consultations during the summer period, 64.2% males). The median age was 3.5 years (p25-75: 2.6-8.4), with 34 had less than 6 years. Thirty-two children were hospitalised. Most drowning occurred in the afternoon (40), in freshwater (49), in private pools (33) and unprotected (33). The victims, mostly healthy children (40), did not know how to swim (38) and were not wearing flotation systems (37/38). There was lack of supervision in 42 cases. Acidosis (20) and hypoxaemia (18) were the most frequent findings. Five children died, 4 were healthy, none knew how to swim or had a float device, and none were supervised. Thirty six children required CPR, mostly applied by family (15). In the children who died, CPR was started after 3min. Two survivors had hemiparesis. ConclusionsAccidental drowning was a rare cause of consultation in paediatric emergency departments. In children less than 6 years, who did not know how to swim, did not use flotation devices in unprotected private pools, and were not properly supervised, there is an increased of suffering from accidental drowning and its associated morbidity. An immersion time> 10min, starting CPR > 3min, acidosis, hyponatraemia, and hypothermia on arrival at the emergency department increases mortality. Training family members in cardiopulmonary resuscitation can be useful.