Vomiting is not associated with poor outcomes in pediatric victims of unintentional submersions

Introduction: The outcome of submersion victims depends on submersion duration and the availability of timely and effective resuscitation. The prognostic implication of vomiting during resuscitation of submersion victims is unclear. The study sought to determine whether vomiting during resuscitation in children treated for unintentional submersion injuries adversely impacts outcome.

Methods: This was a retrospective study of unintentional submersion victims under age 18 treated at an urban tertiary-care children's hospital from 2003-2009. Submersion and victim details were obtained from hospital, EMS, and fatality records. Outcomes studied were survival at 24 hours and condition (Favorable: good/mild impairment or Poor: death/severe disability) at hospital discharge. Descriptive comparisons between emesis groups (yes/no) and categorical covariates were analyzed.

Results: There were 281 victims. The median age was 3 years; 66% were males. Most incidents occurred at swimming pools (77%) and bathtubs (16%). Most were hospitalized (83%). The presence or absence of emesis was documented in 246 (88%). Victims with emesis were significantly less likely to have apnea or be intubated in the ED, have a low ED GCS or die. No patient who had emesis died at 24 hours or had a poor outcome at hospital discharge. Victims who had emesis post-resuscitation were significantly more likely to have received CPR or chest compressions than rescue breaths.

Conclusions: Emesis in pediatric submersion victims is inversely associated with death at 24 hours or poor outcome at hospital discharge. The relationship between emesis and the adequacy of resuscitation of pediatric submersion victims needs to be further studied.