title: Factors Associated With Poor Outcome in Childhood Swimming Pool Submersions.
abstract: OBJECTIVE
  The aims of the study were to determine factors associated with poor outcome in childhood swimming pool submersions and to study the association of bystander resuscitation with clinical outcome.
  
  
  METHODS
  This was a retrospective study of swimming pool submersion victims younger than 18 years in a metropolitan area from 2003 to 2007. Submersion, prehospital, and victim data were obtained from hospital, Emergency Medical Services, and fatality records. Outcome based on survival at hospital discharge was favorable (baseline/mild impairment) or poor (death/severe impairment). Logistic regression determined factors associated with poor outcome.
  
  
  RESULTS
  There were 260 submersions. Outcomes were available for 211 (81%). The median age was 4 years; 68% were males. Most incidents occurred at single residential pools (48%) and multiresidential pools (35%). Mortality was 23%; 75% had favorable outcomes. Favorable outcomes occurred in 8.6% (3/35) of victims with absent pulse at the scene. Descriptive analyses revealed significant differences in submersions that occurred on weekdays, during the summer, submersions lasting 5 minutes or more, with on-scene apnea or cardiac arrest needing cardiopulmonary resuscitation, rescuer type, and transfer to tertiary care. Logistic regression revealed that poor outcome was significantly associated with prolonged submersions and those that occurred on a weekday. Furthermore, hospitalization reduced the odds of a poor outcome by 81% when compared with victims who were not hospitalized. Bystander resuscitation was not significantly associated with outcome.
  
  
  CONCLUSIONS
  Childhood swimming pool submersions, which occur on weekdays and with prolonged submersion times, are associated with poor outcome. Bystander resuscitation is not significantly associated with outcome.
authors.affiliation: From the *Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital; †Department of Emergency Medicine, University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital; ‡Trauma Services, Texas Children's Hospital, Houston; and §Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX.
authors.forename: Rohit P
authors.initials: RP
authors.lastname: Shenoi
authors.forename: Christine E
authors.initials: CE
authors.lastname: Koerner
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Cruz
authors.forename: Mary H
authors.initials: MH
authors.lastname: Frost
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Jones
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Camp
authors.forename: Sartaj
authors.initials: S
authors.lastname: Alam
authors.forename: John J
authors.initials: JJ
authors.lastname: Fraser
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004332:Drowning / Q000453:epidemiology / Q000401:mortality*; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D015701:Near Drowning / Q000453:epidemiology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D013551:Swimming Pools