Pediatric Seawater Drowning in a Turkish Coastal Province: A 13-Year Retrospective Analysis

Pediatric Seawater Drowning in a Turkish Coastal Province: A 13-Year Retrospective Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pediatric Seawater Drowning in a Turkish Coastal Province: A 13-Year Retrospective Analysis Şeyma ŞİMŞİRGİL KARA, Teoman ERŞEN, Özhan ÖZCAN, Sema TURAL BOZOĞLU, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7348579/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Pediatric drowning remains a significant global public health challenge, particularly in coastal regions with seasonal tourism. Despite its clinical importance, detailed data from Türkiye’s pediatric population are limited. This study aimed to evaluate the demographic, clinical, and laboratory characteristics of pediatric seawater drowning cases and identify factors associated with mortality. Methods A retrospective, cross-sectional study was conducted at a referral emergency department (ED) in Türkiye, encompassing pediatric patients (0–18 years) admitted for seawater drowning between July 2011 and July 2024. Data were extracted from institutional and national electronic health systems. Data on demographics, prehospital response, clinical presentation, laboratory findings, radiological results, interventions, and outcomes were collected. All eligible cases were included regardless of data completeness, and no exclusion criteria were applied based on variable availability. Survivors and non-survivors were compared across clinical and biochemical variables. Results A total of 66 pediatric drowning cases were included (mean age: 10.64 ± 4.86 years; 60.6% male). Most incidents occurred in July or August (92.4%) and during daytime hours (12:00–18:00). The overall mortality rate was 10.6%. Prehospital and in-ED cardiopulmonary resuscitation, intubation, low Glasgow Coma Scale (GCS) scores, and high Szpilman scores were significantly associated with mortality (p < 0.001). Non-survivors had significantly lower pH and bicarbonate, and elevated levels of pCO₂, lactate, creatinine, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, potassium, and sodium (p < 0.05). Radiological findings such as chest X-ray or computed tomography lesions were more common among non-survivors but did not reach statistical significance. drowning seawater pediatrics prognosis epidemiology Turkey Introduction This study provides one of the most detailed and up-to-date analyses of pediatric drowning cases in Türkiye, encompassing a 13-year period and integrating clinical, biochemical, radiological, and outcome-based parameters. Despite its preventable nature, pediatric drowning remains a significant contributor to childhood morbidity and mortality 1 , 2 . While numerous international studies have described the epidemiology and acute management of drowning 3 , 4 , research specifically addressing Türkiye’s pediatric population—particularly in coastal provinces where seasonal tourism and seawater exposure are common—remains limited 5 . By addressing this critical knowledge gap, our study aims to inform both clinical decision-making and regionally tailored public health strategies. Pediatric drowning is recognized globally as one of the leading causes of preventable morbidity and mortality in childhood 1 , 2 . Recent estimates suggest that children account for a disproportionately high number of drowning-related deaths, particularly in low- and middle-income countries 6 . The incidence and outcome of drowning are shaped by multiple factors, including geographic and environmental conditions, socioeconomic background, and child-specific behavioral traits. Children aged 1 to 4 years are at the highest risk due to limited motor coordination and underdeveloped swimming capabilities 6 – 8 . Behavioral elements such as insufficient supervision are also strongly implicated in the etiology of drowning events 8 . Epidemiological studies consistently report a male predominance in drowning incidents, with approximately 60% of victims being boys—possibly due to higher exposure to risk-taking behaviors and aquatic environments 9 , 10 . Socioeconomic disparities further contribute to drowning risk, as unequal access to water safety education, trained supervision, and timely medical intervention disproportionately affect vulnerable populations 11 . Accurate identification of prognostic factors following pediatric drowning is critical not only for improving survival rates but also for optimizing long-term neurological and functional outcomes in survivors 4 . Prognostic indicators have traditionally been grouped into three domains: event-related clinical and environmental conditions (e.g., submersion time, water temperature), resuscitative efforts (timing and quality of cardiopulmonary resuscitation), and patient-specific factors (e.g., age, comorbidities) 3 . In particular, the duration of hypoxia and delays in initiating life support have emerged as key determinants of neurological outcome 12 . Neurological assessment tools such as the Glasgow Coma Scale (GCS) and the Szpilman classification have shown prognostic utility in post-drowning evaluation, with low GCS scores and higher Szpilman grades correlating with adverse outcomes 13 . Similarly, initial blood gas analysis—specifically, low arterial pH, elevated lactate, and high pCO₂ levels—has been associated with poor prognosis in pediatric cohorts 14 , 15 . Radiological evaluation, particularly chest radiography, can also reveal pulmonary infiltrates indicative of aspiration-related injury and has been linked to increased mortality in certain series 16 , 17 . This study aims to provide a comprehensive clinical profile of pediatric drowning cases presented to a referral emergency department in Türkiye over a 13-year period. Specifically, the study examines demographic variables, clinical presentation, laboratory and radiological findings, emergency interventions, and short-term outcomes, with a particular focus on identifying variables associated with in-hospital mortality. Methods Study Design, Setting, and Ethical Considerations This retrospective, cross-sectional study was conducted at a referral emergency department in Türkiye and included all pediatric patients admitted for seawater drowning between July 2011 and July 2024. Drowning cases were identified via the institutional Hospital Information Management System (HIMS), and all eligible cases were included regardless of data completeness. All eligible cases were included regardless of data completeness, and no exclusion criteria were applied based on variable availability. This full-case inclusion approach ensured a comprehensive census over the 13-year period. Ethical approval was obtained from the institutional ethics committee (Approval No: Blinded for Review), and the study was conducted in accordance with the principles of the Declaration of Helsinki. Due to the retrospective nature of the study and the use of anonymized data, the requirement for informed consent was waived. The primary objective of this study was to describe the demographic, clinical, and radiological features of pediatric drowning cases admitted to the ED. The secondary objective was to compare survivors and non-survivors in terms of laboratory parameters and resuscitation-related variables, with the aim of identifying potential indicators associated with mortality. To minimize selection and information bias, all institutional cases meeting the diagnostic criteria were included without restriction. Dual-source data verification and independent double-entry were employed to enhance internal consistency and reliability. In line with international standards, this study adopts the drowning definitions and data reporting guidelines set forth by the World Health Organization and the Utstein-style consensus (2). Cases were categorized as fatal or non-fatal, and core variables—such as demographics, prehospital response, clinical presentation, and outcomes—were collected and reported in accordance with these standardized frameworks. In order to contextualize emergency care delivery, it is important to note that all patients in this study were managed within Türkiye’s national Emergency Medical Services (EMS) system. Ambulances were equipped with advanced life support (ALS) capabilities and staffed by paramedics and emergency medical technicians (EMTs). Although physicians supervised EMS remotely, they were not present on scene. In the study region, average EMS response times typically remained under 10 minutes during the summer season. Study Population and Data Collection Eligible patients were defined as individuals aged 0–18 years who presented to the ED with a clinical diagnosis of drowning, confirmed through electronic medical records and ED documentation. Data were extracted retrospectively using a standardized collection form. Demographic variables included age, sex, and province of residence. Temporal characteristics such as month and time of presentation were recorded to explore seasonal patterns. Clinical data included outcome status (discharged, deceased, transferred), hospital length of stay (ward or ICU), and presence of a family member involved in the same drowning incident. Emergency department disposition was categorized as discharge, ward admission, ICU admission, referral to an external ICU, or ED mortality. Prehospital and in-hospital interventions were recorded, including cardiopulmonary resuscitation (CPR) administration (by EMS and/or in the ED) and endotracheal intubation. Neurological status was assessed on arrival using the Glasgow Coma Scale (GCS), and clinical severity was graded using the Szpilman score. Radiological imaging reports were reviewed to identify pulmonary or neurological abnormalities that were interpreted by the treating clinicians as potentially attributable to the drowning incident. Imaging modalities included posteroanterior chest radiography, chest computed tomography (CT), and brain CT. Laboratory parameters included arterial blood gas values (pH, pCO₂, pO₂, HCO₃⁻, SO₂), pulse oximetry saturation, serum lactate, renal function tests (urea, creatinine), liver enzymes (AST, ALT, LDH), muscle injury markers (CK), and electrolytes (Na⁺, K⁺, Cl⁻). Statistical Analysis Statistical analyses were conducted using IBM SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA). The normality of continuous variables was evaluated using the Shapiro–Wilk test (for sample sizes < 50) or the Kolmogorov–Smirnov test (for ≥ 50), alongside visual inspection via Q–Q plots and histograms. Descriptive statistics were used to summarize the data. Normally distributed continuous variables were presented as mean ± standard deviation (SD), while non-normally distributed variables were reported as median with interquartile range (IQR) and minimum–maximum values. Categorical variables were summarized as frequencies and percentages. Comparisons between survivors and non-survivors were performed using the Mann–Whitney U test for continuous non-parametric variables, and Pearson’s chi-square or Fisher’s exact test for categorical variables, as appropriate. Exact p -values were reported for all inferential tests. Statistical significance was set at p < 0.05. No data imputation was performed. Missing data were retained in the dataset and explicitly identified in the relevant tables. No subgroup, multivariate, or interaction analyses were conducted. Results Patient Demographics and Baseline Characteristics A total of 66 pediatric patients who experienced drowning and presented to the emergency department (ED) between July 2011 and July 2024 were included in the analysis. All cases identified as drowning in the hospital information system and aged 0–18 years were evaluated. No data imputation was performed; missing values were explicitly coded and retained for analysis. The mean age of the patients was 10.64 ± 4.86 years, with a median of 10.93 years (range: 1.9–17.5). Males accounted for 60.6% (n = 40), and females for 39.4% (n = 26). The majority of cases occurred in July (53.0%) and August (39.4%). Of all patients, 46.97% were residents of Sinop and another 46.97% resided in other provinces. The overall hospital discharge rate was 77.3% (n = 51), and mortality occurred in 10.6% (n = 7). Most ED presentations occurred between 12:00 and 18:00 (74.2%). Regarding ED disposition, 37.9% of patients were discharged, 28.8% were admitted to the ward, 7.6% to the intensive care unit (ICU), and 13.6% were referred to external ICUs. Two patients died in the ED (Table 1 ). Table 1 Demographic and Clinical Characteristics of Pediatric Drowning Cases Parameter Mean ± SD / n Median (Min–Max) / % Age 10.64 ± 4.86 10.93 (1.9–17.5) Gender Male 40 60.60% Female 26 39.40% Month of Incident March 1 1.50% June 3 4.50% July 35 53.00% August 26 39.40% September 1 1.50% Province of Residence Sinop 31 46.97% Other 31 46.97% No data 4 6.06% Overall Outcome Deceased 7 10.60% Discharged 51 77.30% No data 8 12.10% Time Interval of ED Presentation (hour) 00:00–06:00 1 1.50% 06:00–12:00 2 3.00% 12:00–18:00 49 74.20% 18:00–24:00 14 21.20% Disposition from ED Discharged 25 37.90% Admitted to Ward 19 28.80% Admitted to ICU 5 7.60% Referred to External ICU 9 13.60% Deceased (in ED) 2 3.00% No data 6 9.10% Drowning Incident Involving a Family Member Yes 18 27.27% No 48 72.73% Length of Stay in Ward 1 day 12 63.16% 2 days 7 36.84% Length of Stay in Intensive Care 1 day 3 60.00% 2 days 1 20.00% 13 days 1 20.00% ED: Emergency Department; ICU: Intensive Care Unit. In 27.3% of cases, at least one accompanying family member was also involved in the same drowning incident. Among patients admitted to the ward, 63.2% (n = 12) had a hospital stay of one day, and 36.8% (n = 7) stayed for two days. Of the five patients admitted to the ICU, three stayed for one day, one for two days, and one for thirteen days (Table 1 ). Clinical and Laboratory Parameters Survivors and non-survivors were compared in terms of demographic, clinical, and laboratory characteristics. The median age was 11.00 years in survivors and 15.49 years in non-survivors ( p = 0.043). The Glasgow Coma Scale (GCS) score was 15 in all survivors and 3 in all non-survivors ( p < 0.001). The median Szpilman score was 1 in survivors and 6 in non-survivors ( p < 0.001) (Table 2 ). Table 2 Comparison of Clinical and Laboratory Characteristics Between Survivors and Non-Survivors Parameter Discharged (n) Median (Q1–Q3) [Min–Max] Deceased (n) Median (Q1–Q3) [Min–Max] Z p-value Missing Data n (%) Age (years) 51 11 (5.76–15.08) [1.9–17.5] 7 15.49 (13.13–17) [6.7–17.3] –2.017 0.043 8 (12.1%) Glasgow Coma Scale (GCS) 50 15 (15–15) [8–15] 7 3 (3–3) [3–3] –6.432 < 0.001 9 (13.6%) Spilman Score 49 1 (1–2) [0–4] 7 6 (5–6) [5–6] –4.682 < 0.001 10 (15.2%) pH 48 7.32 (7.27–7.37) [7.053–7.52] 6 6.57 (6.53–6.81) [6.51–6.85] –3.966 < 0.001 12 (18.2%) PCO₂ (mmHg) 48 42.8 (37.75–45.68) [21.8–59.1] 6 122.3 (94.7–149.78) [92.3–168] –3.964 < 0.001 12 (18.2%) HCO₃ (mmol/L) 48 20.75 (18.6–23) [12.9–25.8] 6 12.2 (9.98–17.03) [8.4–18.6] –3.400 < 0.001 12 (18.2%) SO₂ (%) 47 62.5 (53.9–86.6) [18.8–99.2] 6 28.15 (17.95–44.05) [5.8–86.5] –2.779 0.004 13 (19.7%) Pulse Oximetry SO₂ (%) 35 98 (96–98) [50–100] 6 25 (15–52.5) [0–90] –3.815 < 0.001 25 (37.9%) Lactate (mmol/L) 30 3.93 (2.6–5.68) [0.9–13.5] 4 20.35 (13.1–26.79) [12.62–27] –3.154 < 0.001 32 (48.5%) Urea (mg/dL) 46 24.5 (20.75–28) [10–38] 6 26 (19.75–33.25) [19–34] –0.646 0.532 14 (21.2%) Creatinine (mg/dL) 46 0.63 (0.54–0.75) [0.36–1.18] 6 1.07 (0.8–1.23) [0.74–1.26] –3.340 < 0.001 14 (21.2%) AST (U/L) 46 25.5 (19–31) [13–264] 6 45 (28–276.5) [25–749] –2.653 0.006 14 (21.2%) ALT (U/L) 46 15.5 (11.75–20) [5–74] 6 33 (22–275.5) [19–583] –3.328 < 0.001 14 (21.2%) LDH (U/L) 45 285 (236.3–327.5) [176–1044] 6 359.65 (288–717.58) [279–1688] –2.310 0.019 15 (22.7%) CK (U/L) 44 171.5 (123–209.5) [58–4267] 6 152 (112.5–179.5) [105–238] –0.836 0.418 16 (24.2%) Sodium (mmol/L) 47 141 (139–142) [125–147] 6 152 (151.5–158.5) [150–160] –3.985 < 0.001 13 (19.7%) Chloride (mmol/L) 47 108 (106–112) [100–116] 6 111.5 (108.75–116) [108–119] –1.764 0.079 13 (19.7%) Potassium (mmol/L) 47 4.1 (3.7–4.4) [3.1–5.2] 6 5.4 (4.45–6.5) [3.1–7.1] –2.522 0.009 13 (19.7%) Clinical and laboratory variables were compared between survivors and non-survivors using the Mann–Whitney U test. Results are shown as median (Q1–Q3) [min–max]. Only non-parametric variables are included. Non-survivors had significantly lower arterial pH and bicarbonate levels, and higher partial pressure of carbon dioxide (pCO₂) ( p < 0.001 for all). Arterial oxygen saturation and pulse oximetry values were also significantly lower in non-survivors ( p = 0.004 and p < 0.001, respectively). Lactate levels were significantly elevated in non-survivors ( p < 0.001) (Table 2 ). Serum creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and potassium levels were significantly higher in non-survivors ( p < 0.05 for all). Sodium levels were also significantly higher in non-survivors ( p < 0.001). No statistically significant differences were observed in creatine kinase (CK) or chloride levels (Table 2 ). Emergency Interventions and Radiological Findings Prehospital CPR was performed in 5 of 7 non-survivors (71.4%) and in none of the survivors ( p < 0.001). In the ED, CPR was administered in all non-survivors (n = 7, 100%) and in none of the survivors ( p < 0.001). Endotracheal intubation in the ED was performed in 7 of 7 non-survivors (100%) and in 1 of 51 survivors (2%) ( p < 0.001). No patients underwent prehospital intubation (Table 3 ). Table 3 Comparison of Emergency Interventions Between Survivors and Non-Survivors Variable Survivors n (%) Non-Survivors n (%) χ² p-value Missing Data n (%) Prehospital CPR (by EMS) 39.148 < 0.001 9 (13.6%) No 50 (100%) 2 (28.6%) Yes 0 (0%) 5 (71.4%) CPR in Emergency Department 57.000 < 0.001 9 (13.6%) No 50 (100%) 0 (0%) Yes 0 (0%) 7 (100%) Prehospital Intubation (by EMS) – – 9 (13.6%) No 50 (100%) 7 (100%) Intubation in Emergency Department 48.878 < 0.001 9 (13.6%) No 49 (98%) 0 (0%) Yes 1 (2%) 7 (100%) Emergency interventions were compared between survivors and non-survivors using the Chi-square test with exact p-values. Data are presented as number (percentage). CPR: Cardiopulmonary resuscitation, EMS: Emergency Medical Services. Lesions were observed on chest X-ray in 2 of 6 non-survivors (33.3%) and 3 of 50 survivors (6%) ( p = 0.084). Among those who underwent chest computed tomography (CT), lesions were found in 2 of 6 non-survivors (33.3%) and 6 of 50 survivors (12%) ( p = 0.200). Cranial CT demonstrated lesions in 1 of 6 non-survivors (16.7%) and in none of the 50 survivors ( p = 0.107) (Table 4 ). Table 4 Comparison of Radiological Findings Between Survivors and Non-Survivors Radiological Finding Survivors n (%) Non-Survivors n (%) χ² p-value Missing Data n (%) Lesion on Chest X-ray 4.922 0.084 10 (15.2%) No 47 (94%) 4 (66.7%) Yes 3 (6%) 2 (33.3%) Lesion on Chest CT 1.991 0.200 10 (15.2%) No 44 (88%) 4 (66.7%) Yes 6 (12%) 2 (33.3%) Lesion on Brain CT 8.485 0.107 10 (15.2%) No 50 (100%) 5 (83.3%) Yes 0 (0%) 1 (16.7%) Radiological findings were compared between survivors and non-survivors using the Chi-square test with exact p-values. All values are presented as number (percentage). CT: Computed Tomography. Chest X-ray refers to standard posteroanterior (PA) projection. Discussion This study provides one of the most detailed and up-to-date analyses of pediatric drowning cases in Türkiye, encompassing a 13-year period and integrating clinical, biochemical, radiological, and outcome-based parameters. Among 66 pediatric patients evaluated, the overall in-hospital mortality rate was 10.6%, with statistically significant associations observed between mortality and variables such as Glasgow Coma Scale (GCS) score, Szpilman score, arterial blood gas parameters (pH, lactate, pCO₂, bicarbonate), and key biochemical markers including creatinine, AST, ALT, LDH, sodium, and potassium. Furthermore, the finding that 27.3% of cases involved at least one accompanying family member highlights the social and behavioral dimensions of these incidents, including bystander rescue attempts and clustered exposure patterns. These findings emphasize the critical need for early risk stratification, rapid emergency response, and preventive strategies tailored to seasonal and demographic risk profiles. Consistent with previous literature, male sex was predominant (60.6%) among pediatric drowning cases, which aligns with global data identifying male sex as a significant risk factor 10 . Although the mean age in our cohort was approximately 10.6 years, children under 5 years accounted for nearly one-fifth of cases (19.6%). This group, widely recognized as highly vulnerable due to limited motor coordination, insufficient swimming ability, and exploratory behavior, has been repeatedly shown to be at heightened risk for fatal drowning 6 – 8 . Interestingly, our study reported no mortality in this age group, a finding that may reflect protective parenting behaviors prevalent in the local context. In contrast, a higher proportion of fatalities occurred among adolescents aged 15–18 years, suggesting behavioral and environmental risk exposure increases with age. However, age was not independently associated with mortality, likely due to the limited number of fatal cases. The strong seasonal clustering of cases, with over 90% occurring in July and August, underscores the relationship between drowning incidents and tourism-related increases in coastal activity. Approximately half of the patients were non-residents of Sinop, further reinforcing the impact of seasonal tourism. The majority of ED presentations occurred between 12:00 and 18:00, a time window associated with peak beach usage and reduced adult supervision, as also observed in previous studies 9 . The involvement of accompanying family members in over one-quarter of cases reflects a recurring theme in drowning literature: the risk of multi-victim incidents during rescue attempts. Prior research from Türkiye reported that in nearly half of such attempts, rescuers themselves died 18 . This highlights the urgent need for public education regarding safe rescue protocols and structured water safety training, particularly for caregivers and adolescents. The mortality rate observed in our study (10.6%) is somewhat lower than rates reported in similar pediatric cohorts globally. For instance, Güzel et al. (2013) reported a mortality rate of ~ 20% 5 , while a nationwide analysis from Thailand found pediatric drowning mortality to be 12.6% 19 . Variations may be explained by differences in emergency response times, availability of resuscitation, geographic factors, and population behavior. As expected, neurological status at admission was strongly predictive of outcome. All non-survivors had a GCS score of 3 and a median Szpilman score of 6, compared to a GCS of 15 and Szpilman score of 1 among survivors—findings consistent with prior reports underscoring the prognostic value of these clinical scores 20 , 21 . Laboratory markers further corroborated poor perfusion and multi-organ dysfunction in non-survivors. Severe metabolic derangements such as marked acidosis (mean pH 6.57), hypercapnia (pCO₂ 122.3 mmHg), elevated lactate (20.35 mmol/L), and low bicarbonate (12.2 mmol/L) were observed. These findings are in line with previous studies showing that pH < 7.0, lactate ≥ 14 mmol/L, and bicarbonate < 15 mmol/L are highly predictive of mortality or severe neurological outcomes 21 , 22 . Similarly, elevations in AST, ALT, and LDH have been consistently associated with adverse outcomes in pediatric drowning 21 , 23 . Our study also found significantly higher serum sodium and potassium concentrations in non-survivors, both of which are markers of cellular injury and water-electrolyte imbalance in drowning victims. Although radiographic findings did not reach statistical significance, lesions on posteroanterior chest X-ray were more common in non-survivors (33.3% vs. 6%). Prior studies have suggested that early radiographic abnormalities—often indicative of aspiration-related pulmonary edema—are associated with higher rates of clinical deterioration and worse outcomes 16 , 17 , 24 , 25 . Our findings, although limited by sample size, suggest a similar trend and warrant further investigation in larger cohorts. The need for resuscitation and intubation was also strongly associated with mortality. All non-survivors received CPR both prehospitally and in the ED, and all were intubated upon arrival. In contrast, none of the survivors required CPR, and only one survivor (2%) underwent intubation. These findings mirror previous literature demonstrating that the need for advanced airway management and prolonged CPR are robust indicators of poor outcome 21 . Timely and effective prehospital intervention—especially Basic Life Support—remains critical in altering the trajectory of submersion injuries in children. In conclusion, this study provides essential epidemiologic and clinical insights into pediatric drowning in a coastal region of Türkiye. The results underscore the importance of targeted preventive strategies, particularly for adolescents and during peak summer months. Early recognition of prognostic indicators such as Szpilman and GCS scores, arterial blood gas profiles, and specific biochemical markers may support clinical decision-making and improve outcomes. Future multicenter prospective studies are needed to further define the prognostic utility of these variables and guide evidence-based drowning management protocols. Limitations This study has several limitations inherent to its retrospective and single-center design. First, certain clinical variables and long-term outcomes could not be retrieved, particularly for patients referred to external institutions, limiting the assessment of neurological sequelae and functional recovery. Second, the relatively small number of fatal cases may have reduced the statistical power to detect differences in some subgroup analyses. Third, although imaging and laboratory parameters were interpreted using standardized protocols, the retrospective nature of data extraction may have introduced observer variability. Additionally, all drowning incidents occurred in a seawater setting, which limits the generalizability of the findings to freshwater or swimming pool drownings, where pathophysiological and clinical profiles may differ. Lastly, the findings are specific to a coastal region of Türkiye and may not fully reflect drowning patterns in other geographic or healthcare contexts. Moreover, the retrospective design may have introduced selection and information bias, and the absence of standardized data for all cases could limit the precision of some estimates. The direction and magnitude of such bias are uncertain but may have led to underestimation or overestimation of some associations. Conclusion This 13-year retrospective analysis of pediatric seawater drowning cases in a Turkish coastal region underscores the enduring burden of drowning among children, particularly during summer months. Early neurological status, Szpilman score, and key biochemical parameters—including arterial pH, lactate, and serum creatinine—were strongly associated with mortality. These findings highlight the prognostic utility of early clinical and laboratory indicators in emergency settings. The absence of fatalities among younger children and the high frequency of cases involving visiting families emphasize the critical need for targeted public education and seasonal risk mitigation strategies. Future efforts should focus on multicenter prospective studies, development of region-specific drowning risk models, and implementation of scalable preventive interventions—particularly in coastal regions with high seasonal tourist influx. Integration of standardized reporting frameworks and improved inter-institutional data sharing may further enhance national drowning surveillance and inform public health policy. Abbreviations ED Emergency Department ICU Intensive Care Unit EMS Emergency Medical Services ALS Advanced Life Support EMT Emergency Medical Technician GCS Glasgow Coma Scale CPR Cardiopulmonary Resuscitation CT Computed Tomography PA Posteroanterior (used for chest radiographs) HIMS Hospital Information Management System pH Potential of Hydrogen (acid-base balance indicator) pCO₂ Partial Pressure of Carbon Dioxide pO₂ Partial Pressure of Oxygen HCO₃⁻ Bicarbonate SO₂ Arterial Oxygen Saturation AST Aspartate Aminotransferase ALT Alanine Aminotransferase LDH Lactate Dehydrogenase CK Creatine Kinase Na⁺ Sodium K⁺ Potassium Cl⁻ Chloride IQR Interquartile Range SD Standard Deviation Declarations Ethics approval and consent to participate This study was approved by the Sinop University Local Ethics Committee (Decision No: 196; April 2025). Due to the retrospective nature of the study and the use of anonymized data, the requirement for informed consent was waived. The study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki and its later amendments. Consent for publication Not applicable. Availability of data and materials The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no conflict of interest. Funding The authors received no specific funding for this work. Authors’ contributions Conceptualization : ŞŞK, TE, KÖ, ÖO Methodology : ŞŞK (lead), TE, KÖ, ÖO, STB, DS Data curation : ŞŞK, TE, STB, DS Formal analysis : ŞŞK, TE, KÖ (lead), ÖO Investigation : ŞŞK, TE, OÖ, STB, DS, KÖ Visualization : KÖ, ŞŞK, DS, STB Writing – original draft : ŞŞK (lead), KÖ, ÖO Writing – review & editing : All authors Supervision : ŞŞK, KÖ(lead), TE, ÖO Project administration : ŞŞK, TE, KÖ, ÖO Validation : ŞŞK, TE, ÖO, STB, DS, KÖ Author initials : ŞŞK = Şeyma Şimşirgil Kara TE = Teoman Erşen ÖÖ = Özhan Özcan STB = Sema Tural Bozoğlu DS = Dilek Sağır KÖ = Kıvanç Öncü All authors read and approved the final manuscript. Acknowledgements All individuals who contributed to this manuscript are listed as authors; no external professional writing or editorial assistance was used. Clinical trial number Not applicable. References Peden M, Oyegbite K, Ozanne-Smith J, et al. editors. World Report on Child Injury Prevention. Geneva: World Health Organization; 2008. Van Beeck EF, Branche CM, Szpilman D, Modell JH, Bierens JJ. A new definition of drowning: towards documentation and prevention of a global public health problem. Bull World Health Organ. 2005;83:853–6. Quan L, Bierens JJ, Lis R, Rowhani-Rahbar A, Morley P, Perkins GD. Predicting outcome of drowning at the scene: A systematic review and meta-analyses. Resuscitation. 2016;104:63–75. 10.1016/j.resuscitation.2016.04.006 . Bierens JJ, Lunetta P, Tipton M, Warner DS. Physiology Of Drowning: A Review. Physiol (Bethesda). 2016;31(2):147–66. 10.1152/physiol.00002.2015 . Güzel A, Duran L, Paksu S, et al. Drowning and near-drowning: experience of a university hospital in the Black Sea region. Turk J Pediatr. 2013;55(6):620–7. Bellini T, Baffi S, Brisca G, et al. Individual, environmental and demographic factors may play a role in the prognosis of fatal and non-fatal paediatric drowning. Acta Paediatr. 2024;113(6):1412–9. 10.1111/apa.17016 . Rahman A, Alonge O, Bhuiyan AA et al. Epidemiology of Drowning in Bangladesh: An Update. Int J Environ Res Public Health . 2017;14(5):488. Published 2017 May 5. 10.3390/ijerph14050488 Morrongiello BA, Sandomierski M, Spence JR. Changes over swim lessons in parents’ perceptions of children’s supervision needs in drowning risk situations: His swimming has improved so now he can keep himself safe. Health Psychol. 2014;33(7):608–15. https://doi.org/10.1037/a0033881 . Chavkin M, Ohana Sarna Cahan L, Shavit I, et al. Morbidity and Mortality of Drowning Children in Jerusalem District - Retrospective Analysis. Prehosp Disaster Med. 2024;39(6):436–41. 10.1017/S1049023X24000645 . Banihani S, Waldrop I, K Singh M, Vukcevich O, Sheets NW, Plurad D. Unintentional Drownings in Pediatric Populations: Injury Prevention in the Post-COVID-19 Era. Cureus. 2023;15(4):e38264. 10.7759/cureus.38264 . Published 2023 Apr 28. Willcox-Pidgeon SM, Franklin RC, Leggat PA, Devine S. Identifying a gap in drowning prevention: high-risk populations. Inj Prev. 2020;26(3):279–88. 10.1136/injuryprev-2019-043432 . Suominen PK, Vähätalo R. Neurologic long term outcome after drowning in children. Scand J Trauma Resusc Emerg Med. 2012;20:55. 10.1186/1757-7241-20-55 . Published 2012 Aug 15. Salas Ballestín A, de Carlos Vicente JC, Frontera Juan G, et al. Prognostic Factors of Children Admitted to a Pediatric Intensive Care Unit After an Episode of Drowning. Pediatr Emerg Care. 2021;37(4):e192–5. 10.1097/PEC.0000000000001554 . Biçer S, Demirkol D, Karaböcüoğlu M, et al. A Rare Cause of Acute Respiratory Distress Syndrome: Near Drowning in Detergent and Sodium Hypo Chlorite Containing Solution. J Pediatr Emerg Intensive Care Med. 2015;2(1):49–54. 10.5505/cayb.2015.25733 . Denny SA, Quan L, Gilchrist J, et al. Prevention of Drowning. Pediatrics. 2021;148(2):e2021052227. 10.1542/peds.2021-052227 . Laursen CB, Davidsen JR, Madsen PH. Utility of lung ultrasound in near-drowning victims. BMJ Case Rep. 2012;2012. 10.1136/bcr.01.2012.5687 . Published 2012 Jun 21. :bcr0120125687. Raissaki M, Ilia S, Katsoula V, Kotziamanis A, Theotokatou D, Briassoulis G. Introducing a Radiography-based Score in Children With Acute Respiratory Failure: A Cross-sectional Study. J Thorac Imaging. 2021;36(5):294–303. 10.1097/RTI.0000000000000585 . Turgut A. A study on multiple drowning syndromes. Int J Inj Contr Saf Promot. 2012;19(1):63–7. 10.1080/17457300.2011.603154 . Niamsanit S, Uppala R, Sitthikarnkha P et al. The epidemiology and outcomes of hospitalized drowning in Thai children: a national data analysis 2015–2019. Scand J Trauma Resusc Emerg Med . 2024;32(1):98. Published 2024 Sep 30. 10.1186/s13049-024-01270-6 Şık N, Şenol HB, Öztürk A, Yılmaz D, Duman M. A reappraisal of childhood drowning in a pediatric emergency department. Am J Emerg Med. 2021;41:90–5. 10.1016/j.ajem.2020.12.059 . Son KL, Hwang SK, Choi HJ. Clinical features and prognostic factors in drowning children: a regional experience. Korean J Pediatr. 2016;59(5):212–7. 10.3345/kjp.2016.59.5.212 . Berger S, Siekmeyer M, Petzold-Quinque S, Kiess W, Merkenschlager A. Drowning and Nonfatal Drowning in Children and Adolescents: A Subsequent Retrospective Data Analysis. Child (Basel). 2024;11(4):439. 10.3390/children11040439 . Published 2024 Apr 6. Baracat EC, Moreira MR, Belluomini F, dos Reis MC, Brandão MB, et al. Submersion in Children: Prognostic Indicators on PICU Admission. Arch Emerg Med Crit Care. 2017;2(2):1024. 10.47739/2476-2016/1024 . Ho BJ, Crowe JE, Dorfman SR, Camp EA, Yusuf S, Shenoi RP. Correlation of clinical and chest radiograph findings in pediatric submersion cases. Pediatr Radiol. 2020;50(4):492–500. 10.1007/s00247-019-04588-x . Bellini T, Brisca G, D'Alessandro M, et al. Association between early radiographic chest findings and clinical outcomes in pediatric drowning: a retrospective study in a tertiary Italian hospital. Eur J Pediatr. 2025;184(2):187. 10.1007/s00431-025-06029-4 . Published 2025 Feb 11. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 13 May, 2026 Reviews received at journal 26 Sep, 2025 Reviewers agreed at journal 16 Sep, 2025 Reviewers invited by journal 16 Sep, 2025 Editor invited by journal 19 Aug, 2025 Editor assigned by journal 19 Aug, 2025 Submission checks completed at journal 19 Aug, 2025 First submitted to journal 11 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7348579","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":519389428,"identity":"1776d763-f8bd-402d-9108-29682396362c","order_by":0,"name":"Şeyma ŞİMŞİRGİL KARA","email":"","orcid":"","institution":"Sinop University","correspondingAuthor":false,"prefix":"","firstName":"Şeyma","middleName":"ŞİMŞİRGİL","lastName":"KARA","suffix":""},{"id":519389429,"identity":"5edf4917-0097-4114-821d-3fc30a7a33b3","order_by":1,"name":"Teoman ERŞEN","email":"","orcid":"","institution":"Sinop Atatürk State 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07:38:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1254378,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7348579/v1/3620843c-db0f-4c0a-bbe5-0e138a0e233a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pediatric Seawater Drowning in a Turkish Coastal Province: A 13-Year Retrospective Analysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThis study provides one of the most detailed and up-to-date analyses of pediatric drowning cases in T\u0026uuml;rkiye, encompassing a 13-year period and integrating clinical, biochemical, radiological, and outcome-based parameters. Despite its preventable nature, pediatric drowning remains a significant contributor to childhood morbidity and mortality \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. While numerous international studies have described the epidemiology and acute management of drowning \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, research specifically addressing T\u0026uuml;rkiye\u0026rsquo;s pediatric population\u0026mdash;particularly in coastal provinces where seasonal tourism and seawater exposure are common\u0026mdash;remains limited \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. By addressing this critical knowledge gap, our study aims to inform both clinical decision-making and regionally tailored public health strategies.\u003c/p\u003e\u003cp\u003ePediatric drowning is recognized globally as one of the leading causes of preventable morbidity and mortality in childhood \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Recent estimates suggest that children account for a disproportionately high number of drowning-related deaths, particularly in low- and middle-income countries \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The incidence and outcome of drowning are shaped by multiple factors, including geographic and environmental conditions, socioeconomic background, and child-specific behavioral traits. Children aged 1 to 4 years are at the highest risk due to limited motor coordination and underdeveloped swimming capabilities \u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Behavioral elements such as insufficient supervision are also strongly implicated in the etiology of drowning events \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eEpidemiological studies consistently report a male predominance in drowning incidents, with approximately 60% of victims being boys\u0026mdash;possibly due to higher exposure to risk-taking behaviors and aquatic environments \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Socioeconomic disparities further contribute to drowning risk, as unequal access to water safety education, trained supervision, and timely medical intervention disproportionately affect vulnerable populations \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eAccurate identification of prognostic factors following pediatric drowning is critical not only for improving survival rates but also for optimizing long-term neurological and functional outcomes in survivors \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Prognostic indicators have traditionally been grouped into three domains: event-related clinical and environmental conditions (e.g., submersion time, water temperature), resuscitative efforts (timing and quality of cardiopulmonary resuscitation), and patient-specific factors (e.g., age, comorbidities) \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. In particular, the duration of hypoxia and delays in initiating life support have emerged as key determinants of neurological outcome \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eNeurological assessment tools such as the Glasgow Coma Scale (GCS) and the Szpilman classification have shown prognostic utility in post-drowning evaluation, with low GCS scores and higher Szpilman grades correlating with adverse outcomes \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Similarly, initial blood gas analysis\u0026mdash;specifically, low arterial pH, elevated lactate, and high pCO₂ levels\u0026mdash;has been associated with poor prognosis in pediatric cohorts \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Radiological evaluation, particularly chest radiography, can also reveal pulmonary infiltrates indicative of aspiration-related injury and has been linked to increased mortality in certain series \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study aims to provide a comprehensive clinical profile of pediatric drowning cases presented to a referral emergency department in T\u0026uuml;rkiye over a 13-year period. Specifically, the study examines demographic variables, clinical presentation, laboratory and radiological findings, emergency interventions, and short-term outcomes, with a particular focus on identifying variables associated with in-hospital mortality.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Design, Setting, and Ethical Considerations\u003c/h2\u003e\u003cp\u003eThis retrospective, cross-sectional study was conducted at a referral emergency department in T\u0026uuml;rkiye and included all pediatric patients admitted for seawater drowning between July 2011 and July 2024. Drowning cases were identified via the institutional Hospital Information Management System (HIMS), and all eligible cases were included regardless of data completeness. All eligible cases were included regardless of data completeness, and no exclusion criteria were applied based on variable availability. This full-case inclusion approach ensured a comprehensive census over the 13-year period.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e was obtained from the institutional ethics committee (Approval No: Blinded for Review), and the study was conducted in accordance with the principles of the Declaration of Helsinki. Due to the retrospective nature of the study and the use of anonymized data, the requirement for informed consent was waived.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThe primary objective of this study was to describe the demographic, clinical, and radiological features of pediatric drowning cases admitted to the ED. The secondary objective was to compare survivors and non-survivors in terms of laboratory parameters and resuscitation-related variables, with the aim of identifying potential indicators associated with mortality.\u003c/p\u003e\u003cp\u003eTo minimize selection and information bias, all institutional cases meeting the diagnostic criteria were included without restriction. Dual-source data verification and independent double-entry were employed to enhance internal consistency and reliability.\u003c/p\u003e\u003cp\u003e In line with international standards, this study adopts the drowning definitions and data reporting guidelines set forth by the World Health Organization and the Utstein-style consensus (2). Cases were categorized as fatal or non-fatal, and core variables\u0026mdash;such as demographics, prehospital response, clinical presentation, and outcomes\u0026mdash;were collected and reported in accordance with these standardized frameworks.\u003c/p\u003e\u003cp\u003eIn order to contextualize emergency care delivery, it is important to note that all patients in this study were managed within T\u0026uuml;rkiye\u0026rsquo;s national Emergency Medical Services (EMS) system. Ambulances were equipped with advanced life support (ALS) capabilities and staffed by paramedics and emergency medical technicians (EMTs). Although physicians supervised EMS remotely, they were not present on scene. In the study region, average EMS response times typically remained under 10 minutes during the summer season.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Population and Data Collection\u003c/h3\u003e\n\u003cp\u003eEligible patients were defined as individuals aged 0\u0026ndash;18 years who presented to the ED with a clinical diagnosis of drowning, confirmed through electronic medical records and ED documentation. Data were extracted retrospectively using a standardized collection form. Demographic variables included age, sex, and province of residence. Temporal characteristics such as month and time of presentation were recorded to explore seasonal patterns.\u003c/p\u003e\u003cp\u003eClinical data included outcome status (discharged, deceased, transferred), hospital length of stay (ward or ICU), and presence of a family member involved in the same drowning incident. Emergency department disposition was categorized as discharge, ward admission, ICU admission, referral to an external ICU, or ED mortality.\u003c/p\u003e\u003cp\u003ePrehospital and in-hospital interventions were recorded, including cardiopulmonary resuscitation (CPR) administration (by EMS and/or in the ED) and endotracheal intubation. Neurological status was assessed on arrival using the Glasgow Coma Scale (GCS), and clinical severity was graded using the Szpilman score.\u003c/p\u003e\u003cp\u003eRadiological imaging reports were reviewed to identify pulmonary or neurological abnormalities that were interpreted by the treating clinicians as potentially attributable to the drowning incident. Imaging modalities included posteroanterior chest radiography, chest computed tomography (CT), and brain CT. Laboratory parameters included arterial blood gas values (pH, pCO₂, pO₂, HCO₃⁻, SO₂), pulse oximetry saturation, serum lactate, renal function tests (urea, creatinine), liver enzymes (AST, ALT, LDH), muscle injury markers (CK), and electrolytes (Na⁺, K⁺, Cl⁻).\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were conducted using IBM SPSS Statistics version 25.0 (IBM Corp., Armonk, NY, USA). The normality of continuous variables was evaluated using the Shapiro\u0026ndash;Wilk test (for sample sizes\u0026thinsp;\u0026lt;\u0026thinsp;50) or the Kolmogorov\u0026ndash;Smirnov test (for \u0026ge;\u0026thinsp;50), alongside visual inspection via Q\u0026ndash;Q plots and histograms.\u003c/p\u003e\u003cp\u003eDescriptive statistics were used to summarize the data. Normally distributed continuous variables were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), while non-normally distributed variables were reported as median with interquartile range (IQR) and minimum\u0026ndash;maximum values. Categorical variables were summarized as frequencies and percentages.\u003c/p\u003e\u003cp\u003eComparisons between survivors and non-survivors were performed using the Mann\u0026ndash;Whitney U test for continuous non-parametric variables, and Pearson\u0026rsquo;s chi-square or Fisher\u0026rsquo;s exact test for categorical variables, as appropriate. Exact \u003cem\u003ep\u003c/em\u003e-values were reported for all inferential tests. Statistical significance was set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003eNo data imputation was performed. Missing data were retained in the dataset and explicitly identified in the relevant tables. No subgroup, multivariate, or interaction analyses were conducted.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003ePatient Demographics and Baseline Characteristics\u003c/h2\u003e\u003cp\u003eA total of 66 pediatric patients who experienced drowning and presented to the emergency department (ED) between July 2011 and July 2024 were included in the analysis. All cases identified as drowning in the hospital information system and aged 0\u0026ndash;18 years were evaluated. No data imputation was performed; missing values were explicitly coded and retained for analysis.\u003c/p\u003e\u003cp\u003eThe mean age of the patients was 10.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86 years, with a median of 10.93 years (range: 1.9\u0026ndash;17.5). Males accounted for 60.6% (n\u0026thinsp;=\u0026thinsp;40), and females for 39.4% (n\u0026thinsp;=\u0026thinsp;26). The majority of cases occurred in July (53.0%) and August (39.4%). Of all patients, 46.97% were residents of Sinop and another 46.97% resided in other provinces. The overall hospital discharge rate was 77.3% (n\u0026thinsp;=\u0026thinsp;51), and mortality occurred in 10.6% (n\u0026thinsp;=\u0026thinsp;7). Most ED presentations occurred between 12:00 and 18:00 (74.2%). Regarding ED disposition, 37.9% of patients were discharged, 28.8% were admitted to the ward, 7.6% to the intensive care unit (ICU), and 13.6% were referred to external ICUs. Two patients died in the ED (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and Clinical Characteristics of Pediatric Drowning Cases\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD / n\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian (Min\u0026ndash;Max) / %\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.93 (1.9\u0026ndash;17.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMonth of Incident\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarch\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJune\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJuly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e53.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAugust\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39.40%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeptember\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eProvince of Residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSinop\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46.97%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e46.97%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo data\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.06%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOverall Outcome\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeceased\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDischarged\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77.30%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo data\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12.10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime Interval of ED Presentation (hour)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e00:00\u0026ndash;06:00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.50%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e06:00\u0026ndash;12:00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12:00\u0026ndash;18:00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e74.20%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18:00\u0026ndash;24:00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e21.20%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDisposition from ED\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDischarged\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.90%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdmitted to Ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.80%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdmitted to ICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReferred to External ICU\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDeceased (in ED)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo data\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.10%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDrowning Incident Involving a Family Member\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27.27%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e72.73%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLength of Stay in Ward\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63.16%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.84%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLength of Stay in Intensive Care\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e60.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13 days\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20.00%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eED: Emergency Department; ICU: Intensive Care Unit.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn 27.3% of cases, at least one accompanying family member was also involved in the same drowning incident. Among patients admitted to the ward, 63.2% (n\u0026thinsp;=\u0026thinsp;12) had a hospital stay of one day, and 36.8% (n\u0026thinsp;=\u0026thinsp;7) stayed for two days. Of the five patients admitted to the ICU, three stayed for one day, one for two days, and one for thirteen days (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eClinical and Laboratory Parameters\u003c/h2\u003e\u003cp\u003eSurvivors and non-survivors were compared in terms of demographic, clinical, and laboratory characteristics. The median age was 11.00 years in survivors and 15.49 years in non-survivors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.043). The Glasgow Coma Scale (GCS) score was 15 in all survivors and 3 in all non-survivors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The median Szpilman score was 1 in survivors and 6 in non-survivors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Clinical and Laboratory Characteristics Between Survivors and Non-Survivors\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParameter\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDischarged (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedian (Q1\u0026ndash;Q3) [Min\u0026ndash;Max]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDeceased\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMedian (Q1\u0026ndash;Q3) [Min\u0026ndash;Max]\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eZ\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eMissing Data n (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (5.76\u0026ndash;15.08) [1.9\u0026ndash;17.5]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e15.49 (13.13\u0026ndash;17) [6.7\u0026ndash;17.3]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;2.017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.043\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e8 (12.1%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlasgow Coma Scale (GCS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15 (15\u0026ndash;15) [8\u0026ndash;15]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3 (3\u0026ndash;3) [3\u0026ndash;3]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;6.432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e9 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSpilman Score\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1\u0026ndash;2) [0\u0026ndash;4]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6 (5\u0026ndash;6) [5\u0026ndash;6]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;4.682\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e10 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.32 (7.27\u0026ndash;7.37) [7.053\u0026ndash;7.52]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.57 (6.53\u0026ndash;6.81) [6.51\u0026ndash;6.85]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;3.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e12 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePCO₂ (mmHg)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.8 (37.75\u0026ndash;45.68) [21.8\u0026ndash;59.1]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e122.3 (94.7\u0026ndash;149.78) [92.3\u0026ndash;168]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;3.964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e12 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHCO₃ (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.75 (18.6\u0026ndash;23) [12.9\u0026ndash;25.8]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e12.2 (9.98\u0026ndash;17.03) [8.4\u0026ndash;18.6]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;3.400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e12 (18.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSO₂ (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62.5 (53.9\u0026ndash;86.6) [18.8\u0026ndash;99.2]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e28.15 (17.95\u0026ndash;44.05) [5.8\u0026ndash;86.5]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;2.779\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e13 (19.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePulse Oximetry SO₂ (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98 (96\u0026ndash;98) [50\u0026ndash;100]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e25 (15\u0026ndash;52.5) [0\u0026ndash;90]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;3.815\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e25 (37.9%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLactate (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.93 (2.6\u0026ndash;5.68) [0.9\u0026ndash;13.5]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20.35 (13.1\u0026ndash;26.79) [12.62\u0026ndash;27]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;3.154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e32 (48.5%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrea (mg/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.5 (20.75\u0026ndash;28) [10\u0026ndash;38]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26 (19.75\u0026ndash;33.25) [19\u0026ndash;34]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;0.646\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e14 (21.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCreatinine (mg/dL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.63 (0.54\u0026ndash;0.75) [0.36\u0026ndash;1.18]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.07 (0.8\u0026ndash;1.23) [0.74\u0026ndash;1.26]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;3.340\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e14 (21.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAST (U/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.5 (19\u0026ndash;31) [13\u0026ndash;264]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45 (28\u0026ndash;276.5) [25\u0026ndash;749]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;2.653\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e14 (21.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eALT (U/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.5 (11.75\u0026ndash;20) [5\u0026ndash;74]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33 (22\u0026ndash;275.5) [19\u0026ndash;583]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;3.328\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e14 (21.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLDH (U/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e285 (236.3\u0026ndash;327.5) [176\u0026ndash;1044]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e359.65 (288\u0026ndash;717.58) [279\u0026ndash;1688]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;2.310\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e15 (22.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCK (U/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e171.5 (123\u0026ndash;209.5) [58\u0026ndash;4267]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e152 (112.5\u0026ndash;179.5) [105\u0026ndash;238]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;0.836\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.418\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e16 (24.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSodium (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e141 (139\u0026ndash;142) [125\u0026ndash;147]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e152 (151.5\u0026ndash;158.5) [150\u0026ndash;160]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;3.985\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e13 (19.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChloride (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e108 (106\u0026ndash;112) [100\u0026ndash;116]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e111.5 (108.75\u0026ndash;116) [108\u0026ndash;119]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;1.764\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.079\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e13 (19.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePotassium (mmol/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.1 (3.7\u0026ndash;4.4) [3.1\u0026ndash;5.2]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.4 (4.45\u0026ndash;6.5) [3.1\u0026ndash;7.1]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026ndash;2.522\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e13 (19.7%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eClinical and laboratory variables were compared between survivors and non-survivors using the Mann\u0026ndash;Whitney U test. Results are shown as median (Q1\u0026ndash;Q3) [min\u0026ndash;max]. Only non-parametric variables are included.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eNon-survivors had significantly lower arterial pH and bicarbonate levels, and higher partial pressure of carbon dioxide (pCO₂) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for all). Arterial oxygen saturation and pulse oximetry values were also significantly lower in non-survivors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004 and \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, respectively). Lactate levels were significantly elevated in non-survivors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSerum creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), and potassium levels were significantly higher in non-survivors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all). Sodium levels were also significantly higher in non-survivors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No statistically significant differences were observed in creatine kinase (CK) or chloride levels (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEmergency Interventions and Radiological Findings\u003c/h3\u003e\n\u003cp\u003ePrehospital CPR was performed in 5 of 7 non-survivors (71.4%) and in none of the survivors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In the ED, CPR was administered in all non-survivors (n\u0026thinsp;=\u0026thinsp;7, 100%) and in none of the survivors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Endotracheal intubation in the ED was performed in 7 of 7 non-survivors (100%) and in 1 of 51 survivors (2%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No patients underwent prehospital intubation (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Emergency Interventions Between Survivors and Non-Survivors\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurvivors n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-Survivors n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMissing Data n (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrehospital CPR (by EMS)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (28.6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (71.4%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCPR in Emergency Department\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e57.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrehospital Intubation (by EMS)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026ndash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eIntubation in Emergency Department\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.878\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9 (13.6%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (98%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (2%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eEmergency interventions were compared between survivors and non-survivors using the Chi-square test with exact p-values. Data are presented as number (percentage). CPR: Cardiopulmonary resuscitation, EMS: Emergency Medical Services.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLesions were observed on chest X-ray in 2 of 6 non-survivors (33.3%) and 3 of 50 survivors (6%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.084). Among those who underwent chest computed tomography (CT), lesions were found in 2 of 6 non-survivors (33.3%) and 6 of 50 survivors (12%) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.200). Cranial CT demonstrated lesions in 1 of 6 non-survivors (16.7%) and in none of the 50 survivors (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.107) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Radiological Findings Between Survivors and Non-Survivors\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRadiological Finding\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurvivors n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNon-Survivors n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eχ\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMissing Data n (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLesion on Chest X-ray\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.922\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.084\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47 (94%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (66.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (6%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLesion on Chest CT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.991\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44 (88%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (66.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (12%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (33.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLesion on Brain CT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.485\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10 (15.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (100%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5 (83.3%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0 (0%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1 (16.7%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eRadiological findings were compared between survivors and non-survivors using the Chi-square test with exact p-values. All values are presented as number (percentage). CT: Computed Tomography. Chest X-ray refers to standard posteroanterior (PA) projection.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides one of the most detailed and up-to-date analyses of pediatric drowning cases in T\u0026uuml;rkiye, encompassing a 13-year period and integrating clinical, biochemical, radiological, and outcome-based parameters. Among 66 pediatric patients evaluated, the overall in-hospital mortality rate was 10.6%, with statistically significant associations observed between mortality and variables such as Glasgow Coma Scale (GCS) score, Szpilman score, arterial blood gas parameters (pH, lactate, pCO₂, bicarbonate), and key biochemical markers including creatinine, AST, ALT, LDH, sodium, and potassium. Furthermore, the finding that 27.3% of cases involved at least one accompanying family member highlights the social and behavioral dimensions of these incidents, including bystander rescue attempts and clustered exposure patterns. These findings emphasize the critical need for early risk stratification, rapid emergency response, and preventive strategies tailored to seasonal and demographic risk profiles.\u003c/p\u003e\u003cp\u003eConsistent with previous literature, male sex was predominant (60.6%) among pediatric drowning cases, which aligns with global data identifying male sex as a significant risk factor \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Although the mean age in our cohort was approximately 10.6 years, children under 5 years accounted for nearly one-fifth of cases (19.6%). This group, widely recognized as highly vulnerable due to limited motor coordination, insufficient swimming ability, and exploratory behavior, has been repeatedly shown to be at heightened risk for fatal drowning \u003csup\u003e\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Interestingly, our study reported no mortality in this age group, a finding that may reflect protective parenting behaviors prevalent in the local context. In contrast, a higher proportion of fatalities occurred among adolescents aged 15\u0026ndash;18 years, suggesting behavioral and environmental risk exposure increases with age. However, age was not independently associated with mortality, likely due to the limited number of fatal cases.\u003c/p\u003e\u003cp\u003eThe strong seasonal clustering of cases, with over 90% occurring in July and August, underscores the relationship between drowning incidents and tourism-related increases in coastal activity. Approximately half of the patients were non-residents of Sinop, further reinforcing the impact of seasonal tourism. The majority of ED presentations occurred between 12:00 and 18:00, a time window associated with peak beach usage and reduced adult supervision, as also observed in previous studies \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe involvement of accompanying family members in over one-quarter of cases reflects a recurring theme in drowning literature: the risk of multi-victim incidents during rescue attempts. Prior research from T\u0026uuml;rkiye reported that in nearly half of such attempts, rescuers themselves died \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. This highlights the urgent need for public education regarding safe rescue protocols and structured water safety training, particularly for caregivers and adolescents.\u003c/p\u003e\u003cp\u003eThe mortality rate observed in our study (10.6%) is somewhat lower than rates reported in similar pediatric cohorts globally. For instance, G\u0026uuml;zel et al. (2013) reported a mortality rate of ~\u0026thinsp;20% \u003csup\u003e5\u003c/sup\u003e, while a nationwide analysis from Thailand found pediatric drowning mortality to be 12.6% \u003csup\u003e19\u003c/sup\u003e. Variations may be explained by differences in emergency response times, availability of resuscitation, geographic factors, and population behavior.\u003c/p\u003e\u003cp\u003eAs expected, neurological status at admission was strongly predictive of outcome. All non-survivors had a GCS score of 3 and a median Szpilman score of 6, compared to a GCS of 15 and Szpilman score of 1 among survivors\u0026mdash;findings consistent with prior reports underscoring the prognostic value of these clinical scores \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Laboratory markers further corroborated poor perfusion and multi-organ dysfunction in non-survivors. Severe metabolic derangements such as marked acidosis (mean pH 6.57), hypercapnia (pCO₂ 122.3 mmHg), elevated lactate (20.35 mmol/L), and low bicarbonate (12.2 mmol/L) were observed. These findings are in line with previous studies showing that pH\u0026thinsp;\u0026lt;\u0026thinsp;7.0, lactate\u0026thinsp;\u0026ge;\u0026thinsp;14 mmol/L, and bicarbonate\u0026thinsp;\u0026lt;\u0026thinsp;15 mmol/L are highly predictive of mortality or severe neurological outcomes \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSimilarly, elevations in AST, ALT, and LDH have been consistently associated with adverse outcomes in pediatric drowning \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Our study also found significantly higher serum sodium and potassium concentrations in non-survivors, both of which are markers of cellular injury and water-electrolyte imbalance in drowning victims.\u003c/p\u003e\u003cp\u003eAlthough radiographic findings did not reach statistical significance, lesions on posteroanterior chest X-ray were more common in non-survivors (33.3% vs. 6%). Prior studies have suggested that early radiographic abnormalities\u0026mdash;often indicative of aspiration-related pulmonary edema\u0026mdash;are associated with higher rates of clinical deterioration and worse outcomes \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Our findings, although limited by sample size, suggest a similar trend and warrant further investigation in larger cohorts.\u003c/p\u003e\u003cp\u003eThe need for resuscitation and intubation was also strongly associated with mortality. All non-survivors received CPR both prehospitally and in the ED, and all were intubated upon arrival. In contrast, none of the survivors required CPR, and only one survivor (2%) underwent intubation. These findings mirror previous literature demonstrating that the need for advanced airway management and prolonged CPR are robust indicators of poor outcome \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Timely and effective prehospital intervention\u0026mdash;especially Basic Life Support\u0026mdash;remains critical in altering the trajectory of submersion injuries in children.\u003c/p\u003e\u003cp\u003eIn conclusion, this study provides essential epidemiologic and clinical insights into pediatric drowning in a coastal region of T\u0026uuml;rkiye. The results underscore the importance of targeted preventive strategies, particularly for adolescents and during peak summer months. Early recognition of prognostic indicators such as Szpilman and GCS scores, arterial blood gas profiles, and specific biochemical markers may support clinical decision-making and improve outcomes. Future multicenter prospective studies are needed to further define the prognostic utility of these variables and guide evidence-based drowning management protocols.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThis study has several limitations inherent to its retrospective and single-center design. First, certain clinical variables and long-term outcomes could not be retrieved, particularly for patients referred to external institutions, limiting the assessment of neurological sequelae and functional recovery. Second, the relatively small number of fatal cases may have reduced the statistical power to detect differences in some subgroup analyses. Third, although imaging and laboratory parameters were interpreted using standardized protocols, the retrospective nature of data extraction may have introduced observer variability. Additionally, all drowning incidents occurred in a seawater setting, which limits the generalizability of the findings to freshwater or swimming pool drownings, where pathophysiological and clinical profiles may differ. Lastly, the findings are specific to a coastal region of T\u0026uuml;rkiye and may not fully reflect drowning patterns in other geographic or healthcare contexts.\u003c/p\u003e\u003cp\u003eMoreover, the retrospective design may have introduced selection and information bias, and the absence of standardized data for all cases could limit the precision of some estimates. The direction and magnitude of such bias are uncertain but may have led to underestimation or overestimation of some associations.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis 13-year retrospective analysis of pediatric seawater drowning cases in a Turkish coastal region underscores the enduring burden of drowning among children, particularly during summer months. Early neurological status, Szpilman score, and key biochemical parameters\u0026mdash;including arterial pH, lactate, and serum creatinine\u0026mdash;were strongly associated with mortality. These findings highlight the prognostic utility of early clinical and laboratory indicators in emergency settings. The absence of fatalities among younger children and the high frequency of cases involving visiting families emphasize the critical need for targeted public education and seasonal risk mitigation strategies.\u003c/p\u003e\u003cp\u003eFuture efforts should focus on multicenter prospective studies, development of region-specific drowning risk models, and implementation of scalable preventive interventions\u0026mdash;particularly in coastal regions with high seasonal tourist influx. Integration of standardized reporting frameworks and improved inter-institutional data sharing may further enhance national drowning surveillance and inform public health policy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eED\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Department\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntensive Care Unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEMS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Medical Services\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eALS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdvanced Life Support\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEMT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEmergency Medical Technician\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGCS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGlasgow Coma Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCPR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCardiopulmonary Resuscitation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eComputed Tomography\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePosteroanterior (used for chest radiographs)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHIMS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eHospital Information Management System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003epH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePotential of Hydrogen (acid-base balance indicator)\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003epCO₂\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePartial Pressure of Carbon Dioxide\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003epO₂\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePartial Pressure of Oxygen\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eHCO₃⁻\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBicarbonate\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSO₂\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eArterial Oxygen Saturation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAST\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAspartate Aminotransferase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eALT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAlanine Aminotransferase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLDH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLactate Dehydrogenase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCK\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCreatine Kinase\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNa⁺\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSodium\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eK⁺\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePotassium\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCl⁻\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eChloride\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eInterquartile Range\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eStandard Deviation\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Sinop University Local Ethics Committee (Decision No: 196; April 2025). Due to the retrospective nature of the study and the use of anonymized data, the requirement for informed consent was waived. The study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki and its later amendments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eConceptualization\u003c/strong\u003e: ŞŞK, TE, K\u0026Ouml;, \u0026Ouml;O\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eMethodology\u003c/strong\u003e: ŞŞK (lead), TE, K\u0026Ouml;, \u0026Ouml;O, STB, DS\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eData curation\u003c/strong\u003e: ŞŞK, TE, STB, DS\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eFormal analysis\u003c/strong\u003e: ŞŞK, TE, K\u0026Ouml; (lead), \u0026Ouml;O\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eInvestigation\u003c/strong\u003e: ŞŞK, TE, O\u0026Ouml;, STB, DS, K\u0026Ouml;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eVisualization\u003c/strong\u003e: K\u0026Ouml;, ŞŞK, DS, STB\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWriting \u0026ndash; original draft\u003c/strong\u003e: ŞŞK (lead), K\u0026Ouml;, \u0026Ouml;O\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eWriting \u0026ndash; review \u0026amp; editing\u003c/strong\u003e: All authors\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSupervision\u003c/strong\u003e: ŞŞK, K\u0026Ouml;(lead), TE, \u0026Ouml;O\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eProject administration\u003c/strong\u003e: ŞŞK, TE, K\u0026Ouml;, \u0026Ouml;O\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eValidation\u003c/strong\u003e: ŞŞK, TE, \u0026Ouml;O, STB, DS, K\u0026Ouml;\u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor initials\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eŞŞK = Şeyma Şimşirgil Kara\u003cbr\u003e\u0026nbsp;TE = Teoman Erşen\u003cbr\u003e\u0026nbsp;\u0026Ouml;\u0026Ouml; = \u0026Ouml;zhan \u0026Ouml;zcan\u003cbr\u003e\u0026nbsp;STB = Sema Tural Bozoğlu\u003c/p\u003e\n\u003cp\u003eDS = Dilek Sağır\u003c/p\u003e\n\u003cp\u003eK\u0026Ouml; = Kıvan\u0026ccedil; \u0026Ouml;nc\u0026uuml;\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll individuals who contributed to this manuscript are listed as authors; no external professional writing or editorial assistance was used.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePeden M, Oyegbite K, Ozanne-Smith J, et al. editors. 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Published 2025 Feb 11.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"drowning, seawater, pediatrics, prognosis, epidemiology, Turkey","lastPublishedDoi":"10.21203/rs.3.rs-7348579/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7348579/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003ePediatric drowning remains a significant global public health challenge, particularly in coastal regions with seasonal tourism. Despite its clinical importance, detailed data from T\u0026uuml;rkiye\u0026rsquo;s pediatric population are limited. This study aimed to evaluate the demographic, clinical, and laboratory characteristics of pediatric seawater drowning cases and identify factors associated with mortality.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective, cross-sectional study was conducted at a referral emergency department (ED) in T\u0026uuml;rkiye, encompassing pediatric patients (0\u0026ndash;18 years) admitted for seawater drowning between July 2011 and July 2024. Data were extracted from institutional and national electronic health systems. Data on demographics, prehospital response, clinical presentation, laboratory findings, radiological results, interventions, and outcomes were collected. All eligible cases were included regardless of data completeness, and no exclusion criteria were applied based on variable availability. Survivors and non-survivors were compared across clinical and biochemical variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 66 pediatric drowning cases were included (mean age: 10.64\u0026thinsp;\u0026plusmn;\u0026thinsp;4.86 years; 60.6% male). Most incidents occurred in July or August (92.4%) and during daytime hours (12:00\u0026ndash;18:00). The overall mortality rate was 10.6%. Prehospital and in-ED cardiopulmonary resuscitation, intubation, low Glasgow Coma Scale (GCS) scores, and high Szpilman scores were significantly associated with mortality (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Non-survivors had significantly lower pH and bicarbonate, and elevated levels of pCO₂, lactate, creatinine, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, potassium, and sodium (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Radiological findings such as chest X-ray or computed tomography lesions were more common among non-survivors but did not reach statistical significance.\u003c/p\u003e","manuscriptTitle":"Pediatric Seawater Drowning in a Turkish Coastal Province: A 13-Year Retrospective Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-24 07:22:40","doi":"10.21203/rs.3.rs-7348579/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2026-05-13T09:29:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-27T00:55:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"332598164650883989132902010064243956327","date":"2025-09-16T08:25:21+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-16T05:46:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-19T17:53:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-19T08:38:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-19T08:38:02+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-08-11T16:58:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"27e80e76-d706-4d62-abf7-70f8428fdc45","owner":[],"postedDate":"September 24th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2026-05-13T09:29:28+00:00","index":139,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-24T07:22:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-24 07:22:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7348579","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7348579","identity":"rs-7348579","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}