Pentraxin-3 level in subarachnoid haemorrhage: Is it a prognostic factor?

OBJECTIVE: The current study was planned to investigate the relationship of serum level of pentraxine-3 with various clinical and neurological scales and scores. METHODS: The prospective case-control study was conducted at the Emergency Department of the Ondokuz Mayis University, Samsun, Turkey, from March 2013 to June 2014, and comprised subarachnoid haemorrhage patients and healthy. Pentraxine-3levels were measured from serum samples and compared with sub-groups of the various scales and scores used in the study. Data was analysed using SPSS 15. RESULTS: Of the 77 subjects, 40(52%) were patients and 37(48%) were controls. Pentraxine-3levels in the cases were significantly higher than the controls (p<0.001). Among the cases, pentraxine-3level of the Glasgow Coma Scale sub-group was significantly different between the severe and mild categories (p=0.048). Likewise, pentraxine-3 levels were significantly different in terms of Fisher scale in patients with minor haemorrhage compared to those with massive haemorrhage (p=0.026). Also, pentraxine-3 levels were significantly higher in patients who died compared to those who fully recovered (p=0.042). CONCLUSIONS: There was found to be a relationship between pentraxine-3 level and the clinical severity of subarachnoid haemorrhage patients.

Differences in the effectiveness of serum biomarkers for the diagnosis of bacterial infections in adult and elderly patients admitted to the emergency department.

BACKGROUND/AIM: This study aimed to evaluate the superiority of procalcitonin (PCT), C-reactive protein (CRP) levels, white blood cell (WBC) counts, and erythrocyte sedimentation rate (ESR) in discriminating among infection, systemic inflammatory response syndrome (SIRS), and sepsis, and their differences according to age groups. MATERIALS AND METHODS: The patients were divided into an adult group and a geriatric group (over 65 years) and classified according to the presence of infection, SIRS, and sepsis. The patients' laboratory values (PCT, CRP, WBC, ESR), demographic characteristics, and vital signs were taken into consideration. RESULTS: When the laboratory parameters were evaluated, there were no significant differences in the PCT, WBC, and ESR values between the age groups (P > 0.05). CRP was significantly higher in the adult patient group compared to the geriatric group (P < 0.001). When the two groups were compared in terms of infection, there were no significant differences in the PCT levels and the WBC count (P > 0.05) in SIRS and sepsis. In addition, the CRP levels and the ESR were significantly higher in the adult sepsis patients when compared with the geriatric patients (P < 0.001). CONCLUSION: PCT levels do not distinguish among infection, SIRS, and sepsis in adult and geriatric age groups.

Can empirical hypertonic saline or sodium bicarbonate treatment prevent the development of cardiotoxicity during serious amitriptyline poisoning? Experimental research.

OBJECTIVE: The aim of this experimental study was to investigate whether hypertonic saline or sodium bicarbonate administration prevented the development of cardiotoxicity in rats that received toxic doses of amitriptyline. METHOD: Thirty-six Sprague Dawley rats were used in the study. The animals were divided into six groups. Group 1 received toxic doses of i.p. amitriptyline. Groups 2 and 3 toxic doses of i.p. amitriptyline, plus i.v. sodium bicarbonate and i.v. hypertonic saline, respectively. Group 4 received only i.v. sodium bicarbonate, group 5 received only i.v. hypertonic saline, and group 6 was the control. Electrocardiography was recorded in all rats for a maximum of 60 minutes. Blood samples were obtained to measure the serum levels of sodium and ionised calcium. RESULTS: The survival time was shorter in group 1. In this group, the animals' heart rates also decreased over time, and their QRS and QTc intervals were significantly prolonged. Groups 2 and 3 showed less severe changes in their ECGs and the rats survived for a longer period. The effects of sodium bicarbonate or hypertonic saline treatments on reducing the development of cardiotoxicity were similar. The serum sodium levels decreased in all the amitriptyline-applied groups. Reduction of serum sodium level was most pronounced in group 1. CONCLUSION: Empirical treatment with sodium bicarbonate or hypertonic saline can reduce the development of cardiotoxicity during amitriptyline intoxication. As hypertonic saline has no adverse effects on drug elimination, it should be considered as an alternative to sodium bicarbonate therapy.

The Evaluation of Serum Pentraxin-3 and High-Sensitivity C-Reactive Protein Levels in Patients with Acute Attack of COPD.

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are characterized by the release of inflammatory mediators. The aim of this study was to compare serum levels of pentraxin 3 (PTX3) and high-sensitivity C-reactive protein (hs-CRP) in patients with acute exacerbations of COPD with those of a healthy control group. METHODS: The study included 107 men and 19 women, with mean age of 66.5 (32 - 87) years who were diagnosed with acute COPD exacerbations and 48 healthy individuals as a control group. The serum PTX3 and hs-CRP levels were measured and pulmonary function tests were performed. RESULTS: The mean serum level of the hs-CRP was 39.56 mg/L (10.10 - 262), and it was higher in the COPD group than in the control group (p < 0.0001). The hs-CRP levels increased in accordance with the severity of the COPD (p < 0.0001). The serum PTX3 level was 0.52 pcg/dL (0.42 - 0.56) in acute exacerbations. There was a correlation between the PTX3 levels and the pulmonary function tests, including FEV1, FVC, and FEV1/FVC (r = 0.317, p < 0.001; r = 0.385, p < 0.0001, and r = 0.248, p = 0.001, respectively). CONCLUSIONS: The short pentraxin hs-CRP is elevated in COPD patients with acute exacerbations and correlates with the severity of the disease compared with the long pentraxin PTX3. These results support the idea that hs-CRP can be used as an earlier determinant of inflammation in COPD acute exacerbations and that PTX3 cannot be used as a marker of acute exacerbation and disease severity.

Epidemiology of organophosphate intoxication and predictors of intermediate syndrome.

AIM: To evaluate the usefulness of plasma glucose and serum cholinesterase levels as predictors of organophosphate-induced intermediate syndrome. MATERIALS AND METHODS: Seventy-one organophosphate poisoning patients who were admitted to our emergency department during a 4-year period were evaluated retrospectively. Four patients were excluded from the study due to a lack of medical records. Categorical variables were analyzed using the chi-square test and nonparametric variables were analyzed using the Mann-Whitney U test. RESULTS: Thirty-five (52.2%) patients were male and 32(47.8%) were female. Patients had a mean age of 39.4 ± 15.9 years and 70.1% of the patients were married. Oral intake (68.7%) was the most common method of intoxication, and attempted suicide (67.2%) was the most common cause. The most common organophosphates were methamidophos (20.8%), dichlorvos (19.4%), parathion (7.5%), and methyl parathion (7.5%). Fifty-seven (85%) patients were treated in the emergency observation unit and 10 (15%) patients were admitted to the intensive care unit. Eleven (16%) patients developed intermediate syndrome and had significantly lower levels of serum cholinesterase (P < 0.01) and higher blood glucose levels (P = 0.037). CONCLUSION: Initial serum cholinesterase and glucose levels measured in the emergency department may be a useful marker in predicting organophosphate-induced intermediate syndrome.

The effectiveness of the serum surfactant protein D (Sp-D) level to indicate lung injury in pulmonary embolism.

BACKGROUND: Surfactant protein D (SP-D) is a biomarker specific to the lungs. Our aim was to investigate the relationship between clinical probability scores and the serum levels of SP-D to indicate the severity of lung injury that develops secondary to hypoxia in pulmonary embolism (PE). METHODS: We included three groups in the study: non-massive PE (n = 20), sub-massive PE (n = 20), and the control group (n = 20), which consisted of healthy volunteers. The modified Geneva and Wells clinical probability scoring systems were performed for PE, and the patients were classified as low risk, moderate risk, and high risk. SP-D levels were determined by the enzyme-linked immunosorbent assay. RESULTS: For risk factors, the most significant were deep vein thrombosis (DVT) and immobilization. There was no significant difference in SP-D levels between the patients identified with risk factors and those without risk factors in either the Geneva or Wells scores. Atelectasis was the most common radiographic finding, while tricuspid valve regurgitation was predominant in echocardiography. There was no significant difference between the non-massive PE group and the control group, while SP-D levels of the sub-massive group were significantly higher than the control group. CONCLUSIONS: In our study, SP-D levels were significantly higher in the sub-massive PE group overall. However, further prospective studies are required with a larger number of cases, including patients with massive PE, in order to clarify the findings.

The value of electroencephalography in differential diagnosis of altered mental status in emergency departments.

OBJECTIVE: To evaluate the value of electroencephalography in patients with altered mental status in emergency departments. METHODS: Demographical characteristics, types and aetiologies of seizures, and clinical outcomes of the patients were recorded. Patients were divided into 4 groups according to the complaints of admission: findings and symptoms of seizure; stroke and symptoms of stroke-related seizures; syncope; and metabolic abnormalities and other causes of altered mental status. The electroencephalography findings were classified into 3 groups: epileptiform discharges; paroxysmal electroencephalography abnormalities; and background slowing. Electroencephalography abnormalities in each subgroup were evaluated. SPSS 21 was used for statistical analysis. RESULTS: Of the total 190 patients in the study, 117 (61.6%) had pathological electroencephalography findings. The main reason for electroencephalography in the emergency department was the presence of seizure findings and symptoms in 98 (51.6%) patients. The ratio of electroencephalography abnormality was higher in patients who were admitted with complaints of metabolic abnormality-related consciousness disturbances (p < 0.001). A total of 124 (65.3%) patients had neuroimagings. Electroencephalography abnormalities were found to be significantly higher in patients with neuroimagings compared to those without neuroimagings (p < 0.003). CONCLUSION: Despite advanced neuroimaging techniques, electroencephalography is still an important tool in the differential diagnosis of altered mental status such as epileptic seizures, metabolic abnormalities, pseudo-seizures and syncope.

The prognostic values of GDF-15 in comparison with NT-proBNP in patients with normotensive acute pulmonary embolism.

BACKGROUND: An early prediction of prognosis in pulmonary embolism (PE) is a crucial clinical entity. The aim of the study is to investigate whether growth differentiation factor-15 (GDF-15) or N-terminal pro-brain natriuretic peptide levels (NT-proBNP) can better predict the 30 day overall mortality in patients with normotensive acute PE. METHODS: Patients with a high clinical probability of PE, or with low/intermediate probability and a positive D-dimer test, underwent contrast-enhanced computed tomography and ventilation/perfusion lung scan. Simplified pulmonary embolism severity index, the presence of echocardiographic right ventricular dysfunction, and ROC curve analysis by calculated cut-off value of serum GDF-15 and NT-proBNP levels were evaluated for each individual of study population. RESULTS: The serum levels of GDF-15 and NT-proBNP were found to be significantly higher in patients with PE compared with controls (p < 0.0001). In this study, GDF-15 provided better results compared to NT-proBNP in predicting the short-term or 30 day mortality (p = 0.046 and p = 0.418, respectively). Serum GDF-15 with a cut-off value of > 2943 pg/mL yielded a 75% sensitivity, 68.7% specificity, 91.6% negative predictive value, and 90% accuracy for predicting 30 day overall mortality. The results of these tests were found as 62.5%, 40.6%, 81.2%, and 40% for NT-proBNP (with the cut-off value of > 1409 pg/mL), respectively. CONCLUSIONS: High serum GDF-15 levels may provide better information than NT-proBNP for early death in the subjects with normotensive PE and these patients should be closely followed up.

Computer-based simulation training in emergency medicine designed in the light of malpractice cases.

BACKGROUND: Using computer-based simulation systems in medical education is becoming more and more common. Although the benefits of practicing with these systems in medical education have been demonstrated, advantages of using computer-based simulation in emergency medicine education are less validated. The aim of the present study was to assess the success rates of final year medical students in doing emergency medical treatment and evaluating the effectiveness of computer-based simulation training in improving final year medical students' knowledge. METHODS: Twenty four Students trained with computer-based simulation and completed at least 4 hours of simulation-based education between the dates Feb 1, 2010 - May 1, 2010. Also a control group (traditionally trained, n =24) was chosen. After the end of training, students completed an examination about 5 randomized medical simulation cases. RESULTS: In 5 cases, an average of 3.9 correct medical approaches carried out by computer-based simulation trained students, an average of 2.8 correct medical approaches carried out by traditionally trained group (t = 3.90, p < 0.005). We found that the success of students trained with simulation training in cases which required complicated medical approach, was statistically higher than the ones who didn't take simulation training (p ≤ 0.05). CONCLUSIONS: Computer-based simulation training would be significantly effective in learning of medical treatment algorithms. We thought that these programs can improve the success rate of students especially in doing adequate medical approach to complex emergency cases.

Cerebral fat embolism syndrome after long bone fracture due to gunshot injury.

Cerebral fat embolism syndrome is a lethal complication of long-bone fractures and clinically manifasted with respiratory distress, altered mental status, and petechial rash. We presented a 20-year-old male admitted with gun-shot wounds to his left leg. Twenty-four hours after the event, he had generalized tonic clonic seizures, decorticate posture and a Glascow Coma Scale of seven with localization of painful stimuli. Subsequent magnetic resonance imaging of the brain showed a star-field pattern defining multiple lesions of restricted diffusion. On a 4-week follow-up, he had returned to normal neurological function. Despite the severity of the neurological condition upon initial presentation, the case cerebral fat embolism illustrates that, cerebral dysfunction associated with cerebral fat embolism illustrates reversible.

The evaluation of different treatment protocols for trauma-induced lung injury in rats.

BACKGROUND: Lung contusion is an important factor that affects mortality and morbidity of lung injury after blunt chest trauma (BCT). The present study aims to evaluate the effectiveness of different treatment regimens on BCT-induced lung injury. METHODS: A total of 35 Sprague Dawley rats were divided into five experimental groups (n=7): sham, control; BCT; BCT + MP, BCT group treated with methylprednisolone (MP; 30 mg/kg on first day and 3 mg/kg/d on the following days); BCT + Q, BCT group treated with quercetin (Q; 50 mg/kg/d for seven days); and BCT + MP + Q, BCT group treated with the same doses of MP and Q. Serum Clara Cell Protein-16 (CC-16), thiobarbituric acid reactive substances (TBARS), and superoxide dismutase (SOD) levels were analyzed to determine histopathological changes in the lung tissues. RESULTS: Elevated serum CC-16 and TBARS levels and reduced serum SOD levels were found in the BCT group compared to the Sham group. There was a significant change in the serum CC-16 levels in the BCT + MP group compared to the Sham group. Serum TBARS levels were significantly lower in the BCT + MP and BCT + Q group compared to the BCT group. The combined therapy regimen yielded significantly decreased CC-16 levels and increased serum SOD levels compared to the individual treatment groups. Serum TBARS levels did not significantly differ between the BCT + MP + Q group and the other treatment groups. Compared to the BCT + MP + Q group, the BCT + MP group showed significantly lower alveolar edema (AED) and alveolar exudate (AEX) scores, while the BCT + Q group showed significantly lower peribronchial inflammatory cell infiltration (PICI) and AED scores. CONCLUSIONS: The combined usage of quercetin and low dose MP treatment after initial high dose MP at the early stage of lung injury after BCT is more effective.

Charcoal hemoperfusion in bupropion overdose.

Bupropion is a relatively new and popular medication for depression, with seizures as its major side effect. In the literature, there are insufficient data about hemodialysis following bupropion overdose. A 23-year-old female patient was brought to our emergency department with acute change in mental status and seizure after deliberate self-poisoning with approximately 25-30 tablets of bupropion hydrochloride. Her Glasgow coma scale score was 8/15. The patient underwent hemodialysis about 4 hours later. After 4 hours of extracorporeal treatment, she became conscious and was extubated. We present a case of full recovery after charcoal hemoperfusion following a bupropion overdose.

Evaluation of serum endothelial cell specific molecule-1 (endocan) levels as a biomarker in patients with pulmonary thromboembolism.

The aim of this study was to investigate the relationship between pulmonary thromboembolism (PTE) and serum endocan levels. The study included 46 patients with a diagnosis of PTE and control group (25 healthy individuals). Serum endocan levels in all participants' blood samples were measured. The average age of the individuals was 61.76 ±â€Š16.39 years. There was a significant difference in the serum endocan levels between the patients and those of the control group [321.93 ng/l (111.35-2511.33) and 192.77 ng/l (118.30-309.02), respectively; P < 0.030]. The serum endocan levels in the submassive [469.41 ng/l (258.13-800.54)] and the massive PTE groups [719.18 ng/l (319.84-2511.33)] were statistically higher than those in the control group [192.77 ng/l (118.30-309.02)] (P < 0.001 and P < 0.001, respectively). In addition, there was a statistically significant difference between the serum endocan levels of the nonmassive PTE group [188.57 ng/l (111.35-685.56)] and the submassive PTE group (P < 0.01). The serum endocan levels correlated with the international normalization ratio (INR), right ventricular dilatation (RVD) and SBP (r = 0.418, P = 0.004; r = 0.659, P < 0.001; r = -0.425, P = 0.003, respectively). In conclusion, serum endocan levels can be considered a practicable biomarker to determine the severity of PTEs and follow-up thrombolytic therapy.

Serum prolidase enzyme activity and oxidative stress levels in patients with acute hemorrhagic stroke.

BACKGROUND: It has been indicated that oxidative damage contributes to secondary brain injury in both ischemic and hemorrhagic stroke patients. Collagen is a major component of the extracellular matrix, and prolidase plays a role in collagen synthesis. The aim of this study was to evaluate the serum prolidase activity, nitric oxide (NO) levels, total antioxidant capacity (TAC) and total oxidant status (TOS) in patients with acute hemorrhagic stroke. METHODS: Twenty-five patients with acute hemorrhagic stroke and 25 controls were enrolled. Serum prolidase activity, catalase activity, NO levels, TAC and TOS were measured spectrophotometrically. Oxidative stress index (OSI) was calculated. RESULTS: Serum TAC levels and catalase activity were significantly lower in acute hemorrhagic stroke patients than controls (both, p < 0.001), while NO levels, TOS levels, OSI values and prolidase activity were significantly higher (all, p < 0.01). When patients with acute hemorrhagic stroke were divided according to gender, no differences were observed between females and males in respect to serum prolidase enzyme activity, NO levels, TAC levels, TOS levels and OSI values (all, p > 0.05). CONCLUSIONS: Findings from the study suggest an association between increased oxidative stress levels, decreased antioxidant levels and increased prolidase enzyme activity in patients with acute hemorrhagic stroke compared with controls. More studies are needed to elucidate mechanistic pathways on oxidative stress in patients with acute hemorrhagic stroke.

Serum levels of trace elements and heavy metals in patients with acute hemorrhagic stroke.

Trace elements are essential components of biological structures, but alternatively, they can be toxic at concentrations beyond those necessary for their biological functions. Changes in the concentration of essential trace elements and heavy metals may affect acute hemorrhagic stroke. The aim of this study was to measure serum levels of essential trace elements [iron (Fe), zinc (Zn), manganese (Mn), copper (Cu), and magnesium (Mg)] and heavy metals [cobalt (Co), cadmium (Cd), and lead (Pb)] in patients with acute hemorrhagic stroke. Twenty-six patients with acute hemorrhagic stroke and 29 healthy controls were enrolled. Atomic absorption spectrophotometry (UNICAM-929) was used to measure serum Fe, Cu, Pb, Cd, Zn, Co, Mn and Mg concentrations. Serum Cd, Pb and Fe levels were significantly higher in patients with acute hemorrhagic stroke than controls (p < 0.001), while serum Cu, Zn, Mg and Mn levels were significantly lower (all p < 0.001). However, there was no significant difference between the groups with respect to serum Co levels (p > 0.05). We first demonstrate increased Cd, Pb, and Fe levels; and decreased Cu, Zn, Mg, and Mn levels in patients with acute hemorrhagic stroke. These findings may have diagnostic and prognostic value for acute hemorrhagic stroke. Further studies are required to elucidate the roles of trace elements and heavy metals in patients with acute hemorrhagic stroke.

Serum paraoxonase and arylesterase activities and oxidative stress levels in patients with SSRI intoxication.

Oxidative stress is a critical route of damage in various psychological stress-induced disorders, such as depression. Paraoxonase-1 (PON1) plays an important role as an endogenous free-radical scavenging molecule. The aim of this study was to evaluate the influence of serum PON1 activity and oxidative stress in patients with selective serotonin reuptake inhibitor (SSRI) intoxication. A total of 11 patients with SSRI intoxication and 20 healthy controls were enrolled. The serum total antioxidant capacity (TAC) and malondialdehyde (MDA) levels, as well as the paraoxonase and arylesterase activities, were measured spectrophotometrically. The serum TAC levels and the paraoxonase and arylesterase activities were significantly lower (for all, p < 0.001), whereas the serum MDA levels were significantly higher in the patients with SSRI intoxication than in the controls (p < 0.001). These results indicated that decreased PON1 activity and increased oxidative stress represent alternative mechanisms in SSRI toxicity. More studies are needed to elucidate the role of PON1 activity in the etiology of SSRI intoxication.

Effects of leflunomide on inflamation and fibrosis in bleomycine induced pulmonary fibrosis in wistar albino rats.

PURPOSES: Pulmonary fibrosis is a rare and progressive lung disease with a high mortality rate. The treatment regimens still fail to recover the disease. Leflunomide (LEF) is an immunomodulatory agent with antiproliferative activity that is used for the treatment of rheumatoid arthritis. The purpose of the study is to investigate the potential therapeutic efficacy of LEF in bleomycin (BLM) induced pulmonary fibrosis. METHODS: A total of 21 male, adult wistar albino rats were used. The animals were divided into three groups as control, BLM and BLM plus LEF groups (n=7). In BLM group, mice were treated with intratracheal instillation of BLM (2.5 U/kg). Control group received the same volume of saline instead of BLM. In LEF group, in addition to BLM, LEF (10 mg/kg, daily) was administrated by oral gavage. The effect of LEF on pulmonary inflammation and fibrosis was studied by measurements of serum clara cell protein-16 (CC-16), thiobarbituric acid reactive substance levels (TBARS), superoxide dismutase (SOD) and advanced oxidation protein products (AOPP) levels and lung tissue contents of IL-6, TNF-α and NF-κB by immunhistochemical examinations. RESULTS: LEF significantly increased the level of CC-16 and decreased the level of AOPP (P=0.042 and P=0.003 respectively). Lung tissue contents of IL-6, TNF-α and NF-κB significantly decreased in LEF group compared to BLM group by immunhistochemical examinations (P<0.001). CONCLUSIONS: LEF reduces oxidative stress factors, alveolar inflammation and attenuates lung injury and fibrosis.

Has admission blood pressure any prognostic value in patients with subarachnoid hemorrhage: an emergency department experience.

Hypertension is a well-known risk factor for the development and rupture of cerebral aneurysms. The authors conducted a study to investigate the prognostic value of admission blood pressure (BP) on prognosis in patients with subarachnoid hemorrhage (SAH). Two hundred patients with SAH were divided into two groups according to Hunt Hess score (good prognosis: 1 to 3, and poor prognosis: 4 and 5) and according to death in hospital (surveyed and died). The prognostic factors of SAH and BP changes according to Hunt Hess scores in the acute stages of the event were evaluated. Admission mean arterial BP values of the patients who died in hospital were significantly lower than in the patients who were surveyed (P=.026). The admission mean arterial BP values were found to be lower in the poor prognostic patients (Hunt Hess score of 4 and 5) (P<.001). Decreased admission BP values were found to be associated with poor prognosis and mortality.

Usefulness of heart-type fatty acid binding protein in the emergency department.

The early diagnosis of many diseases is critical, especially in the Emergency Department. Biochemical markers can be helpful for emergency physicians in these critical situations. Heart-type fatty acid binding protein (H-FABP) is one of the promising plasma markers for the detection of tissue injury. H-FABP is known to be released from injured myocardium. It is also expressed in skeletal muscle, the kidney, brain, lactating mammary gland, and placenta. It can be useful in the management of acute coronary syndromes, heart failure, pulmonary embolism, renal and hepatic injury, and some cases of poisonings. In this review, an updated overview of the role of H-FABP in the management of diseases seen frequently in the Emergency Department is presented.

Drowning and near-drowning: experience of a university hospital in the Black Sea region.

The aim of the study was to describe the characteristics of patients who applied to the Emergency Department (ED) due to submersion injury; to recognize the risk factors, complications, causes of death, and the educational needs of families and caregivers about unsafe environments for submersion; and to develop preventive strategies. All patients were analyzed retrospectively according to demographic features, clinical and laboratory findings, association between clinical variables and submersion injuries, and patient outcomes. Fifty-five patients with submersion injury were analyzed. The mean age of patients was 10.9 ± 4.7 years. The most common Szpilman clinical scores were Grade 1 (24 patients, 43.8%), Grade 2 (15 patients, 27.3%), and Grade 5 (10 patients, 18.2%). The common location of the submersion injuries included the sea (74.5%), pool (18.4%), bathtub (7.3%), river (3.6%), and lake (3.6%). A limited swimming ability or exhaustion and suffocation (49.1%) due to unknown reasons were the most common causes of submersion injury among all patients. Most complications were due to aspiration pneumonia and hypoxic ischemic encephalopathy (HIE). Thirty-nine patients (70.9%) were followed in the ED, while 16 patients (29.1%) were admitted to the pediatric intensive care unit (PICU); 11 patients (20.0%) died. All of the risk factors of drowning should be taken into account when designing preventive measures and family education. In addition, all pediatricians should be trained periodically about the complications of submersion and the treatment strategies, particularly in coastal cities and areas where drownings occur frequently.