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Objective: To identify risk factors for clinically-important drowning-associated lung injury (ciDALI) in children., Study Design: This was a cross-sectional study of children (0 through 18 years) who presented to 32 pediatric emergency departments (EDs) from 2010 through 2017. We reviewed demographics, comorbidities, prehospital data, chest radiographs reports, and ED course from emergency medical services, medical, and fatality records. We defined ciDALI as presence of any of the following: (1) drowning deaths without cerebral/cervical spine injuries; (2) supplemental oxygen >8 hours postdrowning; (3) invasive/noninvasive ventilatory support in first 24 hours; or (4) abnormal chest radiographic findings in the first 24 hours without resolution within 8 hours postdrowning. We used mixed-methods logistic regression with site as random effect to identify risk factors and bootstrapping to reduce overfitting., Results: We enrolled 4213 patients (no ciDALI = 3045 [72%]; ciDALI = 1168 [28%]). The median age was 3 years (IQR: 1, 5). The risk factors for patients with ciDALI were age >5 years old (aOR: 2.4 [95% CI: 2.0-3.0]); submersion >5 minutes (aOR: 6.0 [95% CI: 3.5-10.2]); any scene resuscitation (aOR: 3.3 [95% CI: 2.5-4.5]) and at presentation to the ED abnormal mentation (aOR: 6.4 [95% CI: 4.1-10.0]), abnormal heart rate (aOR: 1.8 [95% CI: 1.6-2.1]), abnormal respiratory rate (aOR: 1.8 [95% CI: 1.4-2.3]), hypotension (aOR: 2.8 [95% CI: 1.0-7.4]), and abnormal lung auscultation (OR: 3.9 [95% CI: 2.9-5.4])., Conclusions: Pediatric ciDALI risk factors include older age, scene resuscitation, prolonged submersion, and abnormal pulmonary, hemodynamic, and neurological findings at ED presentation. Prospective research to stratify risks based on submersion-related lung injury is needed to help determine short-term outcome and optimize patient disposition., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Study Objective: Diabetic ketoacidosis is the most common cause of morbidity and mortality in children with type I diabetes mellitus, and cerebral edema is the leading cause of pediatric diabetic ketoacidosis death. Excessive intravenous fluid administration has been implicated as a cause of cerebral edema. We perform an evidence-based emergency medicine review assessing the association of intravenous fluid hydration and cerebral edema., Methods: We searched MEDLINE and EMBASE for comparative studies. Because of the low incidence of cerebral edema, we included observational studies in our review. We sought studies including patients younger than 18 years and with diabetic ketoacidosis. We defined cerebral edema, using clinical, radiographic, pathologic criteria, or treatment for intracranial pressure., Results: Three studies met criteria for this review, of which 2 used fluid volume/body weight per unit of time, and the third measured cumulative total volume during hourly periods. The first 2 studies showed no statistically significant association between intravenous fluid administration and cerebral edema. The third study showed a significant association (odds ratio 6.55; 95% confidence interval 1.38 to 30.97) between the total volume (uncorrected for body weight) of infused fluid and the risk of cerebral edema., Conclusion: Accepting the inherent limitations of observational studies, we found a lack of strong or consistent results implicating rate or volume of fluid administration as a precipitant cause of cerebral edema in patients with diabetic ketoacidosis.