Hypoxia and reperfusion injury are not associated with subdural haemorrhages in young children: A retrospective study of drowning victims, with and without return of spontaneous circulation

Despite lack of an evidence basis, the hypothesis that hypoxia causes subdural haemorrhage (SDH) continues to be raised. Recently, the hypothesis included reperfusion after cardiac arrest as a cause of SDH. To determine the incidence of SDH in children under four years old following severe hypoxia and subsequent reperfusion, fatal drownings in children under four years old who were autopsied between 1974 through 1995 in the Western Washington Drowning Database were reviewed. A total of 88 drowning deaths were identified. Their median age was 2.0 years; 11 per cent (10/88) were under one year old. Fifty-three per cent (47/88) died in the field and 47 per cent (41/88) had temporary return of spontaneous circulation. SDH was identified in none of the children. Intracranial haemorrhage was identified in two children: subarachnoid haemorrhage was found in a neonate who drowned right after birth; the second was an epidural bleed directly below a surgical burr hole. This study provides additional evidence that SDH is not caused by severe hypoxia and reperfusion events.