Original Article

CME Article: Descriptive Epidemiology of Pediatric Drowning Patients Presenting to a Large Southern US Children’s Hospital

Authors: Alicia C. Webb, MD, Austin Wheeler, MD, Alexis Ricci, MD, Blake Foxworthy, MD, Brittany Hinten, BS, Nipam Shah, MBBS, MPH, Kathy W. Monroe, MD, MSQI, Michele H. Nichols, MD

Abstract

Objectives: Drowning is the leading cause of death for children ages 1 to 4, and it is among the leading causes of death for children of all ages. National data show disparities in drowning risk for certain racial groups. This study aimed to describe characteristics of patients presenting after a drowning event to guide focused drowning prevention outreach efforts.

Methods: This was a retrospective chart review study designed to analyze the epidemiologic and demographic characteristics of drowning-related injuries and deaths that presented to a large, urban, southern US pediatric hospital from 2016 to 2019. All patients aged 0 to 19 years were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes for drowning or submersion injuries.

Results: One hundred sixty-two patients met the inclusion criteria for the study. Submersion injuries were most common in the 1- to 5-year-old age group. Fifty-eight percent of patients were male. The analysis of race showed that 65% of patients were White and 33% of patients were Black. Pools were the setting for 78% of drowning events. Fifty-four percent of patients received cardiopulmonary resuscitation. Sixty-four percent of patients required hospitalization after the injury.

Conclusions: Characteristics of drowning victims may vary significantly from national data, depending on the area involved. This finding highlights the need for assessing local data to better inform local outreach. Further research is necessary to understand why such variance exists. Drowning prevention education, tailored toward pool safety and preschool-age children, should be a focus of injury prevention efforts.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Centers for Disease Control and Prevention. Unintentional drowning: get the facts. https://www.cdc.gov/homeandrecreationalsafety/water-safety/waterinjuries-factsheet.html. Accessed July 23, 2020.
 
2. Felton H, Myers J, Liu G, et al. Unintentional, non-fatal drowning of children: US trends and racial/ethnic disparities. BMJ Open 2015;5:e008444.
 
3. Cunningham RM, Walton MA, Carter PM. The major causes of death in children and adolescents in the United States. N Engl J Med 2018;379:2468–2475.
 
4. Wu Y, Huang Y, Schwebel DC, et al. Unintentional child and adolescent drowning mortality from 2000 to 2013 in 21 countries: analysis of the WHO Mortality Database. Int J Environ Res Public Health 2017;14:875.
 
5. Gilchrist J, Parker EM, and the Centers for Disease Control and Prevention. Racial/ethnic disparities in fatal unintentional drowning among persons aged ≤ 29 years—United States, 1999-2010. MMWR Morb Mortal Wkly Rep 2014;63:421–426.
 
6. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). WISQARS injury data. https://www.cdc.gov/injury/wisqars/. Accessed July 23, 2020.
 
7. Bowman SM, Aitken ME, Robbins JM, et al. Trends in US pediatric drowning hospitalizations, 1993-2008. Pediatrics 2012;129:275–281.
 
8. Denny SA, Quan L, Gilchrist J, et al. Prevention of drowning. Pediatrics 2019;143:e20190850.
 
9. Karb RA, Subramanian SV, Fleegler EW. County poverty concentration and disparities in unintentional injury deaths: a fourteen-year analysis of 1.6 million U.S. fatalities. PLoS One 2016;11:e0153516.
 
10. Saluja G, Brenner RA, Trumble AC, et al. Swimming pool drownings among US residents aged 5-24 years: understanding racial/ethnic disparities. Am J Public Health 2006;96:728–733.
 
11. Dakessian A, Bachir R, El Sayed M. Impact of trauma designation levels on survival of drowning victims: an observational study from trauma centers in the United States. Medicine (Baltimore) 2019;98:e17721.
 
12. Myers SL Jr, Cuesta AM, Lai Y. Competitive swimming and racial disparities in drowning. Rev Black Polit Econ 2017;44:77–97.
 
13. US Census Bureau. QuickFacts. https://www.census.gov/quickfacts. Accessed July 23, 2020.
 
14. Theurer WM, Bhavsar AK. Prevention of unintentional childhood injury. Am Fam Physician 2013;87:502–509.
 
15. Slomine BS, Nadkarni VM, Christensen JR, et al. Pediatric cardiac arrest due to drowning and other respiratory etiologies: neurobehavioral outcomes in initially comatose children. Resuscitation 2017;115:178–184.
 
16. Ishaque M, Manning JH, Woolsey MD, et al. White matter tract pathology in pediatric anoxic brain injury from drowning. AJNR Am J Neuroradiol 2017;38:814–819.
 
17. El Sibai R, Bachir R, El Sayed M. Submersion injuries in the United States: patients characteristics and predictors of mortality and morbidity. Injury 2018;49:543–548.
 
18. Thompson DC, Rivara FP. Pool fencing for preventing drowning in children. Cochrane Database Syst Rev 2000;2:CD001047.
 
19. van Beelen ME, Beirens TM, den Hertog P, et al. Effectiveness of web-based tailored advice on parents’ child safety behaviors: randomized controlled trial. J Med Internet Res 2014;16:e17.
 
20. Mercado MC, Quan L, Bennett E, et al. Can you really swim? Validation of self and parental reports of swim skill with an inwater swim test among children attending community pools in Washington state. Inj Prev 2016;22:253–260.
 
21. Brenner RA, Taneja GS, Haynie DL, et al. Association between swimming lessons and drowning in childhood: a case-control study. Arch Pediatr Adolesc Med 2009;163:203–210.
 
22. Pharr J, Irwin C, Layne T, et al. Predictors of swimming ability among children and adolescents in the United States. Sports (Basel) 2018;6:17.
 
23. Boyd C, Levy A, McProud T, et al. Fatal and nonfatal drowning outcomes related to dangerous underwater breath-holding behaviors—New York State, 1988-2011. MMWR Morb Mortal Wkly Rep 2015;64:518–521.
 
24. Mott TF, Latimer KM. Prevention and treatment of drowning. Am Fam Physician 2016;93:576–582.