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 Vol. 20 No. 8, August 1999
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(Pediatrics in Review. 1999;20:255-260.)
© 1999 American Academy of Pediatrics

Near-drowning

Linda Quan, MD*
* Chief, Emergency Services, Children's Hospital Regional Medical Center; Associate Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA.

OBJECTIVES

Upon completion of this article, readers should be able to:

  1. Explain why a side of a house does not provide adequate protection from exposure to a pool.
  2. List the initial steps in caring for submersion victims.
  3. Name the medical condition that places a child at a nearly 13-fold increased risk of drowning.
  4. List the most common events causing morbidity and mortality following a drowning or near-drowning.
  5. Enumerate the poor predictors of outcome in a submersion injury.

Definitions

Drowning or death from submersion injury was described initially in medical examiner reports. Near-drowning, defined as survival following submersion, was described as a clinical problem in pediatric intensive care units. It was not until Pearn described both pediatric near-drowning and drowning in Australia that the entirety of submersion injury was defined.

Epidemiology

Drowning is a major cause of pediatric unintentional death worldwide. In the United States, it is the second major cause of unintentional death among children younger than 20 years of age, second only to motor vehicle deaths. Drowning rates are highest in the western United States; in some western states, such as California and Alaska, it is the major cause of pediatric injury death. This is a very lethal injury; 50% of pediatric submersion victims die, which is among the highest percentage of all reported injuries.

Drowning rates vary with age in discernable patterns. In every country studied, drowning rates are highest among children younger than 5 years and second highest among 15- to 19-year-olds. Nevada and Florida, the states that have the highest drowning rates among those younger than 5 years of age, have some of the highest reported drowning rates in the world. Over the past two decades, drowning rates have been decreasing among all but those younger than 5 years of age.

Remarkably, submersion injury has received little attention, even . . . [Full Text of this Article]






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