Study finds risk factors tied to drowning-related hospitalizations and death

October 25, 2019

NEW ORLEANS - Approximately 1 in 10 children admitted for injuries related to drowning end up dying despite comprehensive medical care after being admitted to a hospital, according to new research being presented at the American Academy of Pediatrics (AAP) 2019 National Conference & Exhibition.

An abstract of the study, "Predictors of In Hospital Mortality in Drowning and Submersion in Children and Adolescents in the United States: A national inpatient database analysis," will be presented on Monday, Oct. 28, in the Ernest N. Morial Convention Center.

"Although there has been a recent decline in drowning-related deaths in children, drowning continues to claim the lives of three children every day in the United States," said abstract author Krishna Kishore Umapathi, MD, a post-residency pediatric cardiology fellow at Rush University Medical Center in Chicago. "It remains the second leading cause of unintentional injury-related death for children ages 1 to 14," he said.

The researchers analyzed 2003-2016 data from a large, population-based inpatient hospitalization database, focusing on all patients up to 20 years of age with a diagnosis of drowning. The data revealed several demographic factors that significantly increased the risk of drowning-related hospitalizations. These included:Researchers also discovered that drowning hospitalizations were most likely to happen on weekends and in a swimming pool, the researchers discovered. The occurred more frequently in the West and South than in the Northeast or Midwest.

The study, which is the first to describe the predictors of mortality in U.S. pediatric drowning-related hospitalizations, also identified complications from drowning that were significantly associated with a child's death after being hospitalized. These included cerebral edema, acute kidney injury, seizures, cardiac arrhythmia, acute respiratory distress syndrome, and multiple organ dysfunction syndrome.

Other factors associated with lower odds of survival after being hospitalized for drowning included a history of autism/intellectual disability, and having needed cardiopulmonary resuscitation, mechanical ventilation, or therapeutic hypothermia.

In addition to the tragic toll drowning has on families and communities, hospitalizations from this preventable injury place a high financial burden on health care system. The average drowning hospitalization charge is $41,000, the study determined.

Abstract authors said they hope their findings help provide better in-hospital care for children admitted for drowning and to increase awareness to prevent child drownings.

"Learning life-saving bystander skills like cardiopulmonary resuscitation and taking precautionary measures like fencing off swimming pools, making life jackets a must, and close parental supervision of kids when they are playing in or near bodies of water can bring these numbers down," Dr. Umapathi said.

Dr. Umapathi will present the research abstract, available below, on Monday, Oct. 28, at 8 a.m. in rooms 383-385 of the conference center and will be available for onsite interviews afterward. To request a phone interview with Dr. Umapathi, journalists may contact AAP media relations or Rush University Medical Center public relations officer Charlies Jolie at charles_l_jolie@rush.edu.

For more information about drowning prevention, visit the AAP parenting website, HealthyChildren.org.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.
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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Abstract Title: Predictors of in hospital mortality in drowning and submersion in children and adolescents in the United States: A national inpatient database analysis

Krishna Kishore Umapathi, MD, presenting author

PURPOSE: Unintentional drowning is the second most leading cause of unintentional injury death among children and adolescents. Although there has been a decline in drowning related deaths in children, recent trends in drowning related hospitalizations have not been reported. Although CDC data and death certificates report the mortality data in drowning, they fail to capture all the associated factors that might have contributed to death. In this study, we explored a large inpatient population-based database and sought to study the associated risk factors that might serve as predictors of in hospital mortality in pediatric drowning. METHODS: We analyzed the discharge data from the National Inpatient Sample (NIS) database and Kid's Inpatient Database (KID). We used non-overlapping years between 2003 and 2016. NIS and KID are part of the Healthcare Cost and Utilization Project (HCUP), sponsored by the Agency for Healthcare Research and Quality (AHRQ). Each sampled discharge record includes information on patient demographics, diagnosis and procedure codes, and hospital characteristics. Data were obtained from the HCUP Central Distributor, with approval from the institutional review board at the Case Western Reserve University - Metro Health Medical Center. We included all patients up to 20 years of age with a diagnosis of drowning and submersion (ICD-9 CM 994.1, ICD-10 CM T75.1) mentioned in any of the diagnosis columns. We identified 10 factors/diagnosis associated with drowning - Arrhythmias, Acute respiratory failure, Mechanical ventilation, ECMO, CPR, Acute Kidney Injury, Cerebral edema, seizures, therapeutic hypothermia were included for analysis. Categorical variables were compared using chi square test and continuous variables using Mann Whitney U test. Multiple logistic regression analysis was used to determine the adjusted odds ratio of independent risk factors using SPSS 24. RESULTS: Table 1 illustrates the characteristics of non-fatal vs fatal pediatric drowning hospitalizations. Age <5, male sex, Caucasian and public insurance are all associated with a significantly increased risk of drowning related hospitalizations. Drowning hospitalization were significantly higher in West and South than in the Northeast or Midwest. Majority of drowning incidents were accidental, happened on weekends and in the swimming pool. In univariate analysis, cerebral edema, AKI, seizures, arrhythmia, ARDS, MODS and history of autism/intellectual disability were significant associated with mortality along with interventions including CPR, ECMO, therapeutic hypothermia. Multivariate analysis showed, younger age group, Caucasian, arrhythmia, AKI, cerebral edema, CPR as significant independent predictors of mortality in drowning. CONCLUSION: Although drowning related hospitalizations in children have been trending down in the past 14 years, it still remains a significant public health problem and a leading cause of mortality. Our study is the first to describe the predictors of mortality in pediatric drowning related hospitalizations in United States.

Table 1: Baseline characteristics of children with non-fatal and fatal drowning in the United States (2003-2016)

AAP media contacts: Lisa Black, 630-626-6084, lblack@aap.org

Laura Alessio, 630-626-6276, lalessio@aap.org

American Academy of Pediatrics

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