Submersion Injuries in the United States Trauma Quality Improvement Program Trauma Registry from 2017 to 2023

Abstract

Introduction

Submersion injuries are rare yet life-threatening events. The Trauma Quality Improvement Program (TQIP) registry is the largest national trauma registry in the United States. We describe the epidemiology and outcomes of submersion injuries in the TQIP registry.

Methods

We analyzed data from the TQIP registry for all encounters with a primary or secondary mechanism that included a submersion or drowning description. We used descriptive statistics to portray encounter data including disposition and survival. We used inferential and multivariable logistic regression analyses to identify associations with survival

Results

From 2017 to 2023, there were a total of 8,014,737 trauma encounters, of which, 1677 met our inclusion criteria of a primary or secondary mechanism that included a submersion injury. Of the 1150 survivors, 656 (57%) were discharged home without additional services planned. In our multivariable logistic regression, we noted the following associations with survival: age in years (unit odds ratio, 0.98; 95% CI, 0.98–0.99), male sex odds ratio 1.25 (95% CI, 0.89–1.73), prehospital arrest odds ratio 0.15 (95% CI, 0.11–0.21), interfacility transfer odds ratio 0.52 (95% CI, 0.37–0.71), any signs of life on arrival odds ratio 11.33 (95% CI, 5.90–21.75), head/neck injury odds ratio 0.42 (95% CI, 0.31–0.58), thorax injury odds ratio 0.36 (95% CI, 0.24–0.55), abdomen injury odds ratio 0.36 (95% CI, 0.24–0.56), extremities injury odds ratio 2.70 (95% CI, 0.65–11.16), skin injury odds ratio 1.49 (95% CI, 0.69–3.21), any in-hospital arrest odds ratio 0.13 (95% CI, 0.08–0.20), emergency department intubation odds ratio 0.97 (95% CI, 0.65–1.43), and hypothermia <35°C odds ratio = 0.30 (95% CI, 0.21–0.44).

Conclusions

Submersion injuries were rare in the TQIP registry. In the setting of trauma, most survived to hospital discharge, of whom most were discharged home. Prehospital arrest, in-hospital arrest, lack of signs of life on arrival to the emergency department, and serious injuries to all body regions were associated with lower survival to discharge.