Quan, Linda, Bierens, Joost J. L. M., Lis, Rebecca, Rowhani-Rahbar, Ali, Morley, Peter and Perkins, Gavin D. (2016) Predicting outcome of drowning at the scene : a systematic review and meta-analyses. Resuscitation, 104 . pp. 63-75. doi:10.1016/j.resuscitation.2016.04.006 ISSN 0300-9572.

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Abstract

Objective

To identify factors available to rescuers at the scene of a drowning that predict favourable outcomes.

Design

Systematic review and meta-analysis.

Data sources

PubMed, Embase and Cochrane Library were searched (1979–2015) without restrictions on age, language or location and references lists of included articles.

Study selection

Cohort and case–control studies reporting submersion duration, age, water temperature, salinity, emergency services response time and survival and/or neurological outcomes were eligible. Two reviewers independently screened articles for inclusion, extracted data, and assessed quality using GRADE. Variables for all factors, including time and temperature intervals, were categorized using those used in the articles. Random effects meta-analyses, study heterogeneity and publication bias were evaluated.

Results

Twenty-four cohort studies met the inclusion criteria.

The strongest predictor was submersion duration. Meta-analysis showed that favourable outcome was associated with shorter compared to longer submersion durations in all time cutoffs evaluated: ≤5–6 min: risk ratio [RR] = 2.90; (95% confidence interval [CI]: 1.73, 4.86); ≤10–11 min: RR = 5.11 (95% CI: 2.03, 12.82); ≤15–25 min: RR = 26.92 (95% CI: 5.06, 143.3). Favourable outcomes were seen with shorter EMS response times (RR = 2.84 (95% CI: 1.08, 7.47)) and salt water versus fresh water 1.16 (95% CI: 1.08, 1.24). No difference in outcome was seen with victim's age, water temperatures, or witnessed versus unwitnessed drownings.

Conclusions

Increasing submersion duration was associated with worse outcomes. Submersion durations <5 min were associated with favourable outcomes, while those >25 min were invariably fatal. This information may be useful to rescuers and EMS systems deciding when to perform a rescue versus a body recovery.

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	Resuscitation
Publisher:	Elsevier Ireland Ltd
ISSN:	0300-9572
Official Date:	July 2016
Dates:	Date Event July 2016 Published 3 May 2016 Available 11 April 2016 Accepted 19 January 2016 Submitted
Volume:	104
Page Range:	pp. 63-75
DOI:	10.1016/j.resuscitation.2016.04.006
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Date of first compliant deposit:	3 August 2016
Date of first compliant Open Access:	3 May 2017

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