Childhood Near-Drowning in Chinju

Woo, Hyang Ok; Park, Chan Hoo

Abstract

PURPOSE
Drowning is the second most common cause of accidental death in children, exceeded only by motor vehicle accidents. The purpose of the present study was to investigate the prognostic factors of near-drowning in children, such as age, sex, season, site of submersion, and initial clinical or laboratory manifestrations, and to formulate preventive strategies for decreasing injuries by drowning.
METHODS
Sixty-one near-drowning children who were admitted to Gyeongsang National Hospital from January, 1988 to August, 1996, were identified. A review of the medical charts provided information concerning the submersion accidents.
RESULTS
Boys had a greater risk of submersion than girls (m=42, F=19). The peak age of 1 to 4 years is consistent with the known propensity of toddlers for accidents. Submersion occurred 21 in the sea, 14 in rivers, 7 in bathtubs, 6 in puddles, 3 in ponds, 3 in swimming pools, 2 in valleys, 2 in water tanks, 2 in Korean classic toilets, and 1 in well. There were differences in the concentrations of electolytes between fresh and salt water submersion. Near-drowning occurred most commonly in summer, but it could be observed all the year round, because of the geographical factor of Chinju. Among 61 cases, 49 cases recovered without significant neurologic sequalae and 12 cases died or survived with severe anoxic encephalopathy. Poor prognostic factors were Glasgow coma scale (GCS) less than 5, body temperature less than 36.0degrees C, initial arterial pH less than 7.10, serum glucose over 300mg/dL, AST and/or ALT over 50IU/L, presence of early convulsion, presence of chest X-ray abnormalities, and need for an artificial ventilation.
CONCLUSIONS
Childhood near-drowning accidents are more frequently observed in Chinju than expected in any other province of Korea. We found that known poor prognostic factors for death or severe neurologic sequalae also were operating in our study population. Preventive measures against drowning and near-drowning through school and local education programs seems to be the most important strategy. If submersion victim is found, a quick appropriate extensive cardiopulmonary resuscitation is important to prevent the death or neurologic sequalae.