Análisis descriptivo de las causas, consecuencias y respuesta de los sistemas de Salud Pública en los ahogamientos pediátricos en Galicia: un estudio retrospectivo de 17 años

• Patricia Sánchez Lloria ; Oscar Jesús Cosido Cobos ; Roberto J. Barcala Furelos ; Jorge Blanco Prieto ^[1] ; Martín Otero Agra ; José Ignacio Muñoz Barús ; Silvia Aranda García ^[2] ; Antonio Rodríguez Núñez
  1. [1] Universidad de Oviedo

     Universidad de Oviedo

     Oviedo, España

     
  2. [2] Universitat de Barcelona

     Universitat de Barcelona

     Barcelona, España

     
• Localización: Revista española de salud pública, ISSN 1135-5727, ISSN-e 2173-9110, Nº. 96, 2022
• Idioma: español
• Títulos paralelos:
  • Descriptive analysis of triggers, outcomes and the response of the health systems of child drowning in Galicia (Spain): a 17-year retrospective study
• Enlaces
  • Texto completo (pdf)
• Resumen
  • español

    FUNDAMENTOS // El ahogamiento es un importante problema de Salud Pública en la etapa infantil. El objetivo de este trabajo fue describir las características, localizaciones, intervenciones y resultados del ahogamiento pediátrico en Galicia durante 17 años.

    MÉTODOS // Se realizó un estudio retrospectivo del 100% de los datos de ahogamiento de personas entre 0 y 14 años de edad del año 2004 a 2020, que fueran atendidos por los servicios de emergencias de Galicia 061. Se analizaron las características del incidente, perfil de la víctima, localización, tipo de asistencia sanitaria recibida y supervivencia respecto a muerte mediante el test Chi Cuadrado para comparar frecuencias relativas, y Odds Ratio para estimar el riesgo.

    RESULTADOS // Se registraron 100 ahogamientos pediátricos. En el 55% la principal causa fue la falta de supervisión. Los niños y niñas de 0-4 años se ahogaban mayoritariamente en piscinas, mientras que los/las adolescentes (10-14 años) en playas. En el 42% de los incidentes el testigo hizo reanimación cardiopulmonar (un 37% incluyó ventilaciones). Los servicios de emergencia tardaron 12 minutos de media en llegar. Un 6% falleció in situ y el resto fueron trasladados al hospital e ingresaron el 47% en UCI, 26% en planta, y 8% cursaron alta en Urgencias (43% con edema pulmonar, 41% con oxígeno suplementario, 13% con VMI/VMNI [ventilación mecánica invasiva/no invasiva]). La neumonía fue una complicación habitual y la supervivencia al alta fue del 77%.

    CONCLUSIONES // Los niños/as más pequeños se ahogan habitualmente en instalaciones acuáticas por falta de supervisión mientras que los/las adolescentes se suelen ahogar en playas marítimas. El inicio de la reanimación por parte de testigos y la rápida respuesta de los servicios de emergencias se asocia a una alta tasa de supervivencia. Numerosos datos fueron perdidos durante el proceso por lo que es necesaria una correcta y unificada codificación del ahogamiento.

  • English

    BACKGROUND // Drowning is one of major public health problem in childhood. The aim of this paper was to describe the characteristics, locations, interventions and outcomes of child drowning in Galicia over 17 years.

    METHODS // Retrospective study of 100% of data of drowning amongst children aged 0-14 in the 2004–2020 period who were attended by the 061 emergency services in Galicia (Spain) was made. The characteristics of the incident, the victim’s profile, location, type of medical care given and whether the victim survived or died were analysed using the Chi Square test to compare relative frequencies, and Odds Ratio to estimate the risk.

    RESULTS // During the period under study, 100 child drownings were recorded. In 55%, the main cause was lack of supervision.

    Young children (aged 0-4) primarily drowned in pools, and pre-teens and teenagers (aged 10-14) in the sea. In 42% of the incidents, bystanders performed CPR (37% included ventilation). Emergency services took 12 minutes on average to arrive at the scene. 6% died in situ and of the rest, were taken to hospital and admitted in 47% PICU, 26% ward, 8% discharged from A&E (43% with pulmonary oedema, 41% with supplemental oxygen, 13% with IMV/NIMV [invasive mechanical ventilation/non-invasive]). Pneumonia was the most common complication and survival to discharge was 77%.

    CONCLUSIONS // Small children usually drown in pools and water facilities because of lack of supervision, whereas adolescents usually drown in the sea. CPR started by bystanders and the fast response of emergency services contributed to a high rate of survival.

    A large amount of data was lost during the process: accurate, standardized coding of drowning is necessary.

• Referencias bibliográficas
  • World Health Organization. Preventing drowning: an implementation guide [Internet]. Geneva: World Health Organization; 2017.
  • Wu Y, Huang Y, Schwebel DC, Hu G. Unintentional Child and Adolescent Drowning Mortality from 2000 to 2013 in 21 Countries: Analysis of the...
  • World Health Organization. Global report on drowning: preventing a leading killer [Internet]. World Health Organization. 2014.
  • Abelairas-Gómez C, Tipton MJ, González-Salvado V, Bierens JJLM. Drowning epidemiology, prevention, pathophysiology, resuscitation, and hospital...
  • Szpilman D, Bierens JJLM, Handley AJ, Orlowski JP. Drowning. N Engl J Med. 2012 May 31;366(22):2102-2110. https://doi.org/10.1056/NEJMra1013317
  • Schyllander J, Janson S, Nyberg C, Eriksson UB, Stark Ekman D. Case analyses of all children’s drowning deaths occurring in Sweden 1998-2007....
  • Dirlik M, Bostancıoğlu B. Child drowning deaths in Aydin province, western Turkey, 2002-2012. Eur J Trauma Emerg Surg. 2015 Dec 1;41(6):683-688....
  • Yang L, Nong QQ, Li CL, Feng QM, Lo SK. Risk factors for childhood drowning in rural regions of a developing country: A case-control study....
  • Ya F, Long D, Jaung MS, Xiaoxuan C, Songlin Y, Huiyun X. Child drowning deaths in Xiamen city and suburbs, People’s Republic of China, 2001-2005....
  • Van Beeck EF, Branche CM, Szpilman D, Modell JH, Bierens JJLM. A new defi nition of drowning: towards documentation and prevention of a global...
  • Loux T, Mansuri F, Brooks SE, Slye N, Lewis B, Lu Y et al. Factors associated with pediatric drowning admissions and outcomes at a trauma...
  • Cohen N, Scolnik D, Rimon A, Balla U, Glatstein M. Childhood Drowning: Review of Patients Presenting to the Emergency Departments of 2 Large...
  • De Oliveira J, Piñeiro-Pereira L, Padrón-Cabo A, Alonso-Calvete A, García-Crespo O, Varela-Casal C et al. Percepciones, conocimientos y educación...
  • Denny SA, Quan L, Gilchrist J, McCallin T, Shenoi R, Yusuf S et al. Prevention of Drowning. Pediatrics. 2019;143(5). https://doi.org/10.1542/peds.2019-0850
  • 15. Raess L, Darms A, Meyer-Heim A. Drowning in Children: Retrospective Analysis of Incident Characteristics, Predicting Parameters, and Long-Term...
  • Rahman F, Bose S, Linnan M, Rahman A, Mashreky S, Haaland B et al. Cost-effectiveness of an injury and drowning prevention program in Bangladesh....
  • Barcala-Furelos R, Carbia-Rodríguez P, Peixoto-Pino L, Abelairas-Gómez C, Rodríguez-Núñez A. Implantación de programas educativos para prevenir...
  • Gaida FJ, Gaida JE. Infant and toddler drowning in Australia: Patterns, risk factors and prevention recommendations. J Paediatr Child Health....
  • Szpilman D, Webber J, Quan L, Bierens J, Morizot-Leite L, Langendorfer SJ et al. Creating a drowning chain of survival. Resuscitation. 2014....
  • Rubio B, Yagüe F, Benítez MT, Esparza MJ, González JC, Sánchez F et al. Recomendaciones sobre la prevención de ahogamientos. An Pediatría....
  • Petrass LA, Blitvich JD. A Lack of Aquatic Rescue Competency: A Drowning Risk Factor for Young Adults Involved in Aquatic Emergencies. J Community...
  • Szpilman D, Tipton M, Sempsrott J, Webber J, Bierens J, Dawes P et al. Drowning timeline: a new systematic model of the drowning process....
  • Lawes JC, Rijksen EJT, Brander RW, Franklin RC, Daw S. Dying to help: Fatal bystander rescues in Australian coastal environments. PLoS One....
  • McCarroll RJ, Brander RW, MacMahan JH, Turner IL, Reniers AJHM, Brown JA et al. Evaluation of swimmer-based rip current escape strategies....
  • Quan L, Bierens JJLMLM, Lis R, Rowhani-Rahbar A, Morley P, Perkins GD. Predicting outcome of drowning at the scene: A systematic review and...
  • Gräsner J-T, Wnent J, Herlitz J, Perkins GD, Lefering R, Tjelmeland I et al. Survival after out-of-hospital cardiac arrest in Europe-Results...
  • Bierens J, Abelairas-Gomez C, Barcala Furelos R, Beerman S, Claesson A, Dunne C et al. Resuscitation and emergency care in drowning: A scoping...
  • Idris AH, Bierens JJLM, Perkins GD, Wenzel V, Nadkarni V, Morley P et al. 2015 revised Utstein-style recommended guidelines for uniform reporting...
  • Davey M, Callinan S, Nertney L. Identifying Risk Factors Associated with Fatal Drowning Accidents in the Paediatric Population: A Review of...
  • Peden AE, Willcox-Pidgeon S. Autism spectrum disorder and unintentional fatal drowning of children and adolescents in Australia: an epidemiological...
  • Guan J, Li G. Injury Mortality in Individuals With Autism. Am J Public Health. 2017;107(5):791–3. https://doi. org/10.2105/AJPH.2017.303696
  • Franklin RC, Pearn JH, Peden AE. Drowning fatalities in childhood: the role of pre-existing medical conditions. Arch Dis Child. 2017;102(10):888-893....
  • Aagaard SK, Dreier JW, Sun Y, Laursen TM, Christensen J. Accidental deaths in young people with epilepsy and psychiatric comorbidity-A Danish...
  • Diekema DS, Quan L, Holt VL. Epilepsy as a risk factor for submersion injury in children. Pediatrics. 1993 Mar;91(3):612-616.
  • Kemp AM, Sibert JR. Epilepsy in children and the risk of drowning. Arch Dis Child. 1993 May;68(5):684-5. https://doi.org/10.1136/adc.68.5.684
  • Bradley T, Dixon J, Easthope R. Unexplained fainting, near drowning and unusual seizures in childhood: screening for long QT syndrome in New...
  • Choi G, Kopplin LJ, Tester DJ, Will ML, Haglund CM, Ackerman MJ. Spectrum and frequency of cardiac channel defects in swimming-triggered arrhythmia...
  • Kieboom JK, Verkade HJ, Burgerhof JG, Bierens JJ, Rheenen PF van, Kneyber MC et al. Outcome after resuscitation beyond 30 minutes in drowned...
  • Suominen PK, Vähätalo R. Neurologic long term outcome after drowning in children. Scand J Trauma Resusc Emerg Med. 2012 Aug 15;20:55. https://doi....