Pattern of presenting complaints recorded as near-drowning events in emergency departments: a national surveillance study from Pakistan.

Siran He,Uzma Rahim Khan,Adnan A Hyder,Nukhba Zia,Khusro Shamim,Jeffrey C Lunnen

doi:10.1186/1471-227x-15-s2-s4

Abstract

BackgroundDrowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap.MethodsPatients who presented with a complaint of "near-drowning" were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the "near-drowning" complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization.ResultsA total of 133 patients (0.2% of all injury patients) with "near-drowning" as presenting complaints were recorded by the Pak-NEDS system. True near-drowning (50.0%) and intentional injuries that led to "near-drowning" complaints (50.0%) differed in nature of injuries. The highest proportion of true near-drowning incidents occurred among patients aged between 25-44 years (47.5%), and among males (77.5%). True near-drowning patients usually had other accompanying complaints, such as lower limb injury (40.0%). Very few patients were transported by ambulance (5.0%), and triage was done for 15% of patients. Eleven (27.5%) true near-drowning patients received cardiopulmonary resuscitation.ConclusionThere was major under-reporting of drowning and near-drowning cases in the surveillance study. The etiology of near-drowning cases should be further studied. Patients who experienced non-fatal drownings were more commonly sent for medical care due to other accompanying conditions, rather than near-drowning event itself. There is also need for recognizing true near-drowning incidents. The results of this study provide information on data source selection, site location, emergency care standardization, and multi-sector collaboration for future drowning prevention studies.

Highlights

Drowning is a heavy burden on the health systems of many countries, including Pakistan
The Pak-NEDS study is an active pilot surveillance study that was conducted between November 2010 and March 2011 in seven urban tertiary care centers situated in five major Pakistani cities of five provinces
Note: Chi-square test could not be applied because the variable is summary of multiple responses. * Obtained relevant information from patients’ main complaints when presenting at the Emergency department (ED); ** Summary of multiple responses, % provided was for individual category, and cannot add up to 100%

Summary

Introduction

Drowning is a heavy burden on the health systems of many countries, including Pakistan. Males, and individuals with easy access to bodies of water have a higher risk of drowning [4] In countries such as the United States, drowning affects more economically active individuals in a community, having many societal impacts that are both negative and difficult to measure [4,7]. Near-drowning events do not result in death, they can leave the survivor temporarily unconscious, functionally impaired, mentally traumatized, or even permanently disabled, which may result in considerable direct and indirect financial costs [8]. These costs are much higher for those with severe chronic sequelae. Death can be prevented if near-drowning cases are managed properly and drowning risk factors can be identified through the investigation of individual near-drowning cases [8]

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