Ahogamientos por inmersión no intencional. Análisis de las circunstancias y perfil epidemiológico de las víctimas atendidas en 21 servicios de urgencias españoles / Unintentional drowning by immersion. Epidemiological profile of victims attended in 21 Spanish emergency departments

Objetivos: Conocer la frecuencia de los ahogamientos por inmersión no intencional (AINI) como motivo de consulta en los servicios de urgencias pediátricos. Definir el perfil epidemiológico de las víctimas. Analizar las circunstancias relacionadas con el pronóstico y la supervivencia. Pacientes y métodos: Estudio multicéntrico, prospectivo y descriptivo sobre víctimas de ahogamientos por inmersión no intencional, visitados en 21 servicios de urgencias pediátricos entre junio y septiembre del 2009 y del 2010, respectivamente. Se recogieron datos de filiación, el entorno, la seguridad, la vigilancia, la necesidad de maniobras de reanimación cardiopulmonar (RCP), la tasa de hospitalización, las secuelas y la mortalidad. Resultados: Sobre 234.566 consultas, 53 correspondieron a ahogamientos no intencionales por inmersión (frecuencia: 2,2/10.000 consultas en periodo estival; 64,2% varones). La mediana de edad fue 3,5 años (p25-75: 2,6-8,4), 34 tenían menos de 6 años. Ingresaron 32 niños. La mayoría de los ahogamientos ocurrieron de tarde (40), en agua dulce (49), en piscinas privadas (33) y desprotegidas (33). Las víctimas, principalmente niños sanos (40), no sabían nadar (38) ni llevaban sistema de flotación (37/38). En 42 casos falló la vigilancia. Acidosis (20) e hipoxemia (18) fueron los hallazgos más frecuentes. Murieron 5 niños, 4 eran sanos, ninguno sabía nadar ni llevaban flotador y en todos falló la vigilancia. Requirieron RCP 36 niños, mayormente aplicadas por familiares (15). En los fallecidos, la RCP se inició después de 3min. Dos sobrevivientes presentaron hemiparesia. Conclusiones: Los AINI constituyen un motivo de consulta poco frecuente en los servicios de urgencias. Tener menos de 6 años de edad, no saber nadar, no usar flotadores en piscinas privadas desprotegidas y una vigilancia inadecuada aumentan el riesgo de sufrir un AINI y su morbilidad. Un tiempo de inmersión>10min, inicio de RCP>3min, acidosis, hiponatremia e hipotermia al llegar a urgencias aumentan la mortalidad. Capacitar a familiares en reanimación cardiopulmonar puede resultar útil (AU)

Objectives: To determine the frequency of accidental drowning seen in paediatric emergency departments, to define the epidemiological profile of the victims, and to analyse the circumstances related to prognosis and survival. Patients and methods: A multicentre, prospective and descriptive study was conducted on victims of accidental drowning seen in 21 paediatric emergency departments between June and September 2009 and 2010. We collected personal, environmental, safety, security data, as well as the need for cardiopulmonary resuscitation (CPR), hospitalisation rate, sequelae and mortality. Results: Out of 234,566 emergency department cases, 53 were due to accidental drowning (frequency: 2.2/10,000 consultations during the summer period, 64.2% males). The median age was 3.5 years (p25-75: 2.6-8.4), with 34 had less than 6 years. Thirty-two children were hospitalised. Most drowning occurred in the afternoon (40), in freshwater (49), in private pools (33) and unprotected (33). The victims, mostly healthy children (40), did not know how to swim (38) and were not wearing flotation systems (37/38). There was lack of supervision in 42 cases. Acidosis (20) and hypoxaemia (18) were the most frequent findings. Five children died, 4 were healthy, none knew how to swim or had a float device, and none were supervised. Thirty six children required CPR, mostly applied by family (15). In the children who died, CPR was started after 3min. Two survivors had hemiparesis. Conclusions: Accidental drowning was a rare cause of consultation in paediatric emergency departments. In children less than 6 years, who did not know how to swim, did not use flotation devices in unprotected private pools, and were not properly supervised, there is an increased of suffering from accidental drowning and its associated morbidity. An immersion time> 10min, starting CPR > 3min, acidosis, hyponatraemia, and hypothermia on arrival at the emergency department increases mortality. Training family members in cardiopulmonary resuscitation can be useful (AU)

[Unintentional drowning by immersion. Epidemiological profile of victims attended in 21 Spanish emergency departments]. / Ahogamientos por inmersión no intencional. Análisis de las circunstancias y perfil epidemiológico de las víctimas atendidas en 21 servicios de urgencias españoles.

OBJECTIVES: To determine the frequency of accidental drowning seen in paediatric emergency departments, to define the epidemiological profile of the victims, and to analyse the circumstances related to prognosis and survival. PATIENTS AND METHODS: A multicentre, prospective and descriptive study was conducted on victims of accidental drowning seen in 21 paediatric emergency departments between June and September 2009 and 2010. We collected personal, environmental, safety, security data, as well as the need for cardiopulmonary resuscitation (CPR), hospitalisation rate, sequelae and mortality. RESULTS: Out of 234,566 emergency department cases, 53 were due to accidental drowning (frequency: 2.2/10,000 consultations during the summer period, 64.2% males). The median age was 3.5 years (p25-75: 2.6-8.4), with 34 had less than 6 years. Thirty-two children were hospitalised. Most drowning occurred in the afternoon (40), in freshwater (49), in private pools (33) and unprotected (33). The victims, mostly healthy children (40), did not know how to swim (38) and were not wearing flotation systems (37/38). There was lack of supervision in 42 cases. Acidosis (20) and hypoxaemia (18) were the most frequent findings. Five children died, 4 were healthy, none knew how to swim or had a float device, and none were supervised. Thirty six children required CPR, mostly applied by family (15). In the children who died, CPR was started after 3 min. Two survivors had hemiparesis. CONCLUSIONS: Accidental drowning was a rare cause of consultation in paediatric emergency departments. In children less than 6 years, who did not know how to swim, did not use flotation devices in unprotected private pools, and were not properly supervised, there is an increased of suffering from accidental drowning and its associated morbidity. An immersion time> 10 min, starting CPR > 3 min, acidosis, hyponatraemia, and hypothermia on arrival at the emergency department increases mortality. Training family members in cardiopulmonary resuscitation can be useful.

Estudio multicéntrico sobre factores de riesgo de lesiones en accidentes de automóvil / Multicentre study on risk factors of injuries in car crashes

Introducción: Los accidentes de tráfico son la principal causa de muerte en niños de entre 2 y 14 años en países desarrollados. En este estudio se analiza la repercusión clínica, las características epidemiológicas, el uso y la adecuación de los sistemas de retención infantil (SRI) y su correlación con el tipo de lesiones en menores de 12 años de edad. Material y métodos: Estudio multicéntrico prospectivo descriptivo. Se recogieron los datos de filiación de las víctimas, los detalles técnicos de los accidentes, el uso y la adecuación del SRI, la clasificación de las lesiones según la localización y la gravedad, la necesidad de hospitalización, el tratamiento médico recibido, la activación del sistema de emergencias y el destino final del lesionado. Resultados: Se estudiaron 366 pacientes, la relación por sexos fue 1:1 y la mediana de edad fue de 6 años. El 69,7% presentó alguna lesión (el 92,3% eran lesiones leves). El 81,1% de las lesiones afectaron la cabeza y el cuello. El 77,9% utilizó algún tipo de SRI (adecuado sólo en el 55,7%). Se encontró mayor infrautilización del SRI en mayores de 6 años (27,1%; p<0,001). Circular en vía interurbana (odds ratio [OR]: 6,7) y no utilizar SRI adecuado (OR: 3,7) se relacionaron con la gravedad de las lesiones. La edad de los pacientes y la posición dentro del automóvil no estuvieron relacionadas. Todos los pacientes con escala de coma de Glasgow inferior a 8 y todos los pacientes fallecidos llevaban SRI inadecuados. Requirieron hospitalización el 8,7% y la tasa de mortalidad a las 24h fue del 0,8%. Conclusiones: Un porcentaje importante de los niños accidentados no utiliza SRI adecuados. La no utilización de un SRI o su utilización inadecuada es un factor de riesgo de morbilidad en los accidentes de tráfico en la infancia (AU)

Introduction: Traffic accidents are the main cause of death in children between 2 and 14 years in developed countries. We analysed their clinical repercussions, epidemiological characteristics, use and suitability of Child Restraint Systems (CRS) and its correlation with the type of injuries in children less than 12 years old. Material and methods: Multicentre descriptive prospective study. The following data was collected: personal details of the victims and the type of accident, use and suitability of the CRS, classification of injuries according to location and severity, need for hospitalisation, medical treatment received, use of Emergency Services and final destination of the injured. Results: A total of 366 patients were studied, with a sex ratio of 1:1 and a mean age of 6 years. Of these, 69.7% had some injury (slight 92.3%). A total of 81.1% affected the head and neck, and 77.9% used some type of CRS (suitable only in 55.7%). CRS were used more in >6 year olds (27.1%-P<0.001). Driving long distances (odds ratio 6.7) and not using a suitable CRS (odds ratio 3.7) were associated with the severity of the injuries. The age of the patients and the position within the automobile were not related. All the patients with a Glasgow less than 8 and all the deceased were using an unsuitable CRS. The hospitalization rate was 8.7% and the mortality rate at 24h was 0.8%. Conclusions: An important percentage of the injured children do not use suitable child restraint systems. Non-use of a CRS or its inadequate use is a risk factor of morbidity in the traffic accidents in childhood (AU)

[Multicentre study on risk factors of injuries in car crashes]. / Estudio multicéntrico sobre factores de riesgo de lesiones en accidentes de automóvil.

INTRODUCTION: Traffic accidents are the main cause of death in children between 2 and 14 years in developed countries. We analysed their clinical repercussions, epidemiological characteristics, use and suitability of Child Restraint Systems (CRS) and its correlation with the type of injuries in children less than 12 years old. MATERIAL AND METHODS: Multicentre descriptive prospective study. The following data was collected: personal details of the victims and the type of accident, use and suitability of the CRS, classification of injuries according to location and severity, need for hospitalisation, medical treatment received, use of Emergency Services and final destination of the injured. RESULTS: A total of 366 patients were studied, with a sex ratio of 1:1 and a mean age of 6 years. Of these, 69.7% had some injury (slight 92.3%). A total of 81.1% affected the head and neck, and 77.9% used some type of CRS (suitable only in 55.7%). CRS were used more in >6 year olds (27.1%-P<0.001). Driving long distances (odds ratio 6.7) and not using a suitable CRS (odds ratio 3.7) were associated with the severity of the injuries. The age of the patients and the position within the automobile were not related. All the patients with a Glasgow less than 8 and all the deceased were using an unsuitable CRS. The hospitalization rate was 8.7% and the mortality rate at 24h was 0.8%. CONCLUSIONS: An important percentage of the injured children do not use suitable child restraint systems. Non-use of a CRS or its inadequate use is a risk factor of morbidity in the traffic accidents in childhood.