O0026: Significant Traumatic Injuries in Pediatric Drownings

Background: Drowning is a leading cause of pediatric morbidity and mortality in the United States (U.S.). Children with increased drowning risk include toddlers, adolescents, males, and those with underlying medical conditions including epilepsy, autism, and cardiac arrhythmias. The role of trauma is poorly described as a cause or sequelae of drowning events. Few prior studies have investigated the incidence of traumatic injuries and injury patterns in pediatric drownings. We sought to determine the prevalence and spectrum of traumatic injuries occurring in pediatric patients presenting with drowning to U.S. children’s hospitals.

Methods: We conducted a retrospective, cross-sectional study of index drowning encounters [International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes T75.1, V90, V92, W16, W22.041, W65-74, X71, X92, Y21] among children ( < 18 years old) treated at 45 geographically diverse children’s hospitals that contributed data to the Pediatric Health Information System between October 1, 2015 to December 31, 2020. Our outcome of interest was significant traumatic injuries, defined as the presence of ICD-10-CM codes for any of the following: major brain injury; cervical, thoracic, and/or lumbar spine fractures; spinal cord injury; thoracic organ injury; intra-abdominal organ injury; pelvic fractures; long-bone fractures; and major vessel injury. We used descriptive statistics to summarize demographic characteristics, complex chronic conditions (CCC) as classified by Feudtner, et al., co-morbid conditions associated with drowning, and CT imaging utilization among the study population. We compared patients with and without significant traumatic injuries using Fisher’s exact tests for categorical variables and Wilcoxon signed rank tests for continuous variables.

Results: We identified 10,397 index drowning encounters. Most children were young (70.2% 0-4 years old) and male (58.5%). Approximately half were Non-Hispanic White (50.4%). CCCs were present in 12.6% of children, 4% had a diagnosis code for seizure disorder, 4.4% for developmental delay, 2.1% for autism and 0.5% for arrhythmia/conduction disorder. There were 238 children (2.3%) with significant traumatic injuries, of which intracranial injury was the most common (1.5%). All other significant traumatic injuries occurred in fewer than 0.5%. Among children who were admitted (N=5490), 198 (3.6%) had significant traumatic injuries. CT imaging was performed in the following proportions: brain (12.2%), cervical spine (3.9%), abdomen/pelvis (1.5%) and chest (0.8%). Patient characteristics associated with significant traumatic injuries included older age, public payor status, lower median household income, and having a CCC, seizure disorder or conduction disorder.

Conclusion: The prevalence of significant traumatic injuries in children with drowning is low and associated with age, proxies for family income, and co-morbid conditions. Further studies are needed to determine if imaging studies are being overused. If overuse is present, there is an opportunity to develop targeted approaches for evaluation of traumatic injuries in children who experience drowning and are at higher risk of significant traumatic injuries.