Presenter Profile
Caitlin Farrell, MD
Department of Pediatrics, Harvard Medical School
Division of Emergency Medicine
Director, Section on EMS and Prehospital Care
Boston Children's Hospital
300 Longwood Ave
Boston, MA 02115
caitlin.farrell@childrens.harvard.edu
Division of Emergency Medicine
Director, Section on EMS and Prehospital Care
Boston Children's Hospital
300 Longwood Ave
Boston, MA 02115
caitlin.farrell@childrens.harvard.edu
Caitlin Farrell is a pediatric emergency medicine physician at Boston Children's Hospital where she leads the Section on Pre-Hospital Care and Emergency Medical Services (EMS). Dr. Farrell's research interests focus on pediatric trauma and injury prevention. Her prior work has included pediatric fractures, motor vehicle safety, firearm-associated injury, and child abuse fatalities. She has a special interest in the pre-hospital care of ill and injured children and works closely with local and regional EMS providers to improve pediatric care through education and collaboration.
Presentations
Prehospital Predictors of Critical Illness in Pediatric Drowning in the United States
Molly Greenshields, MD
Michael Monuteaux, ScD
Angelica Garcia MD, MPH
Kate Dorney, MD MSHPEd
Lois Lee, MD, MPH
Caitlin Farrell, MD
Part of session:
Background:
Drowning is the leading cause of injury related death for children 1-4 years old and the third most common cause of injury related death in youth 5-19 years old. Our objective was to describe the epidemiology of pediatric drowning patients utilizing pre-hospital EMS data in the United States in 2019 and to identify patient-specific, incident-specific, and procedural intervention variables associated with critical illness following drowning.
Methods:
This was a national, cross-sectional study using the 2019 National Emergency Medical Services Information System (NEMSIS) database. Children < 19 years old (yo) with ICD 10 external cause of injury (E-codes) for drowning were included. Critical illness was defined as a recorded Glasgow Coma Scale (GCS) score < 8 or hypoxia <90 by EMS. Demographic and incident characteristics (e.g., season, drowning location) were compared between drowning patients with and without critical illness using Pearson chi square test or Fisher’s exact test. We performed multivariable logistic regression for the outcome of critical illness controlling for demographic and incident characteristics.
Results:
Our study sample included 1160 patients; 57% were children < 5 yo. Drowning occurred most in urban locations (87.6%), during the summer (46.4%), and in swimming pools (43.4%). Critically ill drowning patients comprised 344 (21.6%) of the study population with CPR performed in 61% and advanced airway management performed in 32%. A higher proportion of males compared to females had critical illness (p= 0.013). While the largest number of drownings occurred during summer, spring and fall had higher proportions of patients with critical illness (p =0.013). In the multivariable logistic regression model there were increased odds of critical illness in children 1-4 years compared to 13-19 years (OR 1.61, 95% CI 1.07, 2.44). Males had increased odds of critical illness (OR 1.47, 95% CI 1.11,1.95) in the multivariable logistic regression model. There was no statistically significant difference by U.S. region or drowning location.
Conclusions:
Among children with drowning receiving EMS care, nearly one-quarter were critically ill with a GCS score < 8 or hypoxia <90. Younger children 1-4 years and males had increased odds of critical illness. Using national EMS data is novel in improving understanding of pediatric patients with drowning at risk for critical illness. This can inform injury prevention interventions and EMS preparedness.
Objectives:
1. Nearly one quarter of children evaluated by EMS after drowning were critically ill with GCS <8 or hypoxia <902. Children with increased odds of critical illness after drowning include males and children aged 1-4.
3. National EMS data allows for novel understanding of pediatric drowning.