Epidemiology, Prevention, and Sequelae of Drowning

Tracy E. McCallin; Mickinzie Morgan; Margaret L.I. Hart; Shabana Yusuf

doi:10.1542/pir.2019-0150

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Tracy E. McCallin, MD*
Mickinzie Morgan, MD†
Margaret L.I. Hart, MD‡
Shabana Yusuf, MD, MEd§

^*Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, The Children's Hospital of San Antonio, San Antonio, TX
^†Department of Pediatrics, Texas Tech Health Sciences Center, Lubbock, TX
^‡Office of Student Affairs, Baylor College of Medicine, Houston, TX
^§Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX

Abbreviations:

AAP:: American Academy of Pediatrics
ASD:: autism spectrum disorder
CDC:: Centers for Disease Control and Prevention
CPR:: cardiopulmonary resuscitation
CPSC:: Consumer Product Safety Commission
ED:: emergency department
WHO:: World Health Organization

Practice Gaps

Pediatricians should be aware that drowning is the second leading cause of death for children younger than 14 years.
Clinicians may not know that drowning is the leading cause of unintentional death for children 1 to 4 years of age. Also, the Consumer Product and Safety Commission reports that 69% of drownings occur during nonswim times.
Clinicians should also be aware that drowning prevention is a Bright Futures–recommended anticipatory guidance topic for the 2-month through 10-year health supervision visits.

Objectives

After completing this article, readers should be able to:

Understand new recommendations from the revised American Academy of Pediatrics policy statement on drowning prevention and review management of the drowning victim.
Understand the epidemiology of drowning in the United States and the current evidence relating to various methods of drowning prevention.
Use pediatric drowning statistics and evidence-based water safety counseling strategies to educate patients and caregivers on drowning prevention.

Epidemiology

Drowning is defined as “the process of experiencing respiratory impairment from submersion/immersion in liquid.” (1) A drowning or submersion event is described either as fatal or nonfatal with or without morbidity. Older terms such as near, dry, wet, active, passive, secondary, or delayed drowning are no longer used when describing submersions. The use of consistent terminology is advisable to clarify reporting of drowning data and to drive a cohesive strategy for drowning prevention research.

Fatal and nonfatal drownings are responsible for significant costs to the US health-care system. In 2017, 25% of pediatric nonfatal drowning victims who presented to emergency departments (EDs) required hospitalization or transfer for further management. (2) In 2010, the average lifetime medical and work loss–related costs per hospitalization for drowning were estimated to be $292,300. (2) In 2015, the estimated total medical costs of drowning in the United States for children 19 years and younger were $68.5 million. …