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Examination of Circumstances of Pediatric Drowning and near-Drownings

Monday, October 22, 2012: 4:15 PM
Versailles Ballroom (Hilton Riverside)
Julie N. Phillips, MD1, Purnima Unni, MPH2, Cristina Maria Estrada, MD3 and Stephen E. Morrow, MD, FAAP2, (1)Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville, TN, (2)Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville, TN, (3)Pediatrics, Vanderbilt University Medical Center, Brentwood, TN

Purpose

Drowning is the second leading causes of unintentional injury deaths in children 0 to 19 years of age in the United States. While the South has seen significant decline in drowning related hospitalization rates, these rates are still the highest relative to other regions. Detailed examination of circumstances surrounding drowning and near-drowning cases is needed to guide injury prevention initiatives. Our objective is to describe the nature and circumstances of pediatric drowning and near drowning cases by age.

Methods

A retrospective chart review of drowning and near-drowning patients (January 1, 2005 and October 31, 2010) from the trauma registry and those presenting to the Emergency Department of a level 1 trauma center was conducted. A total of 153 patients below 15 years were identified based on ICD-9 codes. In-depth analysis was also carried out to understand and categorize circumstances and details leading to drownings and near-drownings by age. 

Results

The mean age of patients was 3.5 years (SD = 2.9). Males comprised 62% of the cases. The average length of stay in the hospital was 1.4 days (SD = 2.7). About 41% were released the same day. There were 18 (12%) drowning deaths. The leading site for drowning/near-drownings was private pools (38%), followed by public pools (32%), bathtubs (15%), and open bodies of water (10%). Most cases were associated with no supervision (47%) or intermittent supervision (46%). Lack of supervision was significantly associated with fatalities (p< .05). The majority of cases (75%) presented between May and August.    

Of the 13 infants (< 1 year) in the dataset, 12 cases involved bathtubs. There were no fatalities. There were 105 patients (69%) between 1 and 4 years. Private and public pools accounted for 77% of all cases in this group. This age group accounted for 83% of all the fatalities. There were 24 patients (16%) between 5 to 9 years. The injury site patterns were similar to the 1 to 4 years group.

The most common type of injury was pulmonary-related (44%), followed by anoxic brain injury (17%), and cardiovascular arrest (12%). Majority of these injuries were among the 1 to 4 year-olds. The older children (10-14 years) were particularly prone to cervical/spinal injuries.

Conclusion

Like many injuries, drowning-related injuries are predictable and preventable. In most cases, continuous and vigilant supervision was lacking. Priority should be given to interventions targeting parents of 1-4 year olds. Private pools are a major risk factor. Renewed focus on pool fencing and emphasis on proximal and active supervision is needed. Experts also point to benefits of formal swimming lessons for this group.