Approximately 71 percent of the earth’s surface is covered in water, with the world’s oceans accounting for 96 percent of the planet’s water mass.* However, it does not take a vast body of water to signify a potential threat of drowning.
Swim at your own risk
Drowning is defined as the process of experiencing respiratory impairment from submersion or immersion in liquid with the outcome classifying as death, morbidity, or no morbidity.† In the U.S., each day approximately 10 people die from unintentional drowning, and typically two of these individuals are 14 years of age or younger. Children ages one to four have the highest drowning rates, and, unfortunately, most of them drown in home swimming pools. Drowning is the cause of more deaths among children in this age group than any other cause except congenital anomalies. Among the one-to-14-year-old age group, fatal drowning is only second to motor vehicle crashes in causing unintentional injury deaths. Approximately 80 percent of drowning death victims are male, and drowning is the fifth leading cause of death, regardless of gender, by unintentional injury.‡
Several factors influence drowning risk, including swimming ability, lack of supervision while swimming, swimming pools without adequate barriers, failure to wear life jackets, seizure disorders, and alcohol use.
More than half of drowning victims treated in emergency departments require hospitalization or transfer for further care. This hospitalization rate is almost nine times greater than that of any other unintentional injury. Though not fatal, these hospitalized drowning patients may have sustained brain injury leading to long-term disabilities that affect memory, learning, and impaired activities in daily life.‡
Hospital discharge status
To examine the occurrence of pediatric drowning injuries in the National Trauma Data Bank® (NTDB®) research dataset for 2013, admissions medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnoses codes. Specifically searched were records with age younger than or equal to 19 and external cause of injury codes (E-code) E832 (accidental submersion or drowning in water transport accident), E910 (accidental drowning and submersion), E910.8 (other accidental drowning or submersion), and E910.9 (unspecified accidental drowning or submersion). A total of 59 records were found, and 45 records contained a discharge status, including 30 patients discharged to home and one to acute care/rehab; 14 died. These patients were 71 percent male, on average 7.97 years of age, had an average hospital length of stay of 3.7 days, an intensive care unit length of stay of 3.4 days, an average injury severity score of 9.85, and were on the ventilator for an average of 3.8 days. (See figure.)
Safety first
Of course, it is impossible and undesirable to eliminate exposure to water, but one can take steps to reduce the risk of drowning incidents. Supervise small children when in or around water, including when they are bathing or playing in small plastic pools. Use the buddy system when swimming and choose locations that have lifeguards. Teach children to swim at an early age. For someone with a seizure disorder, provide one-to-one supervision. To protect your children, keep your home pool safe by installing a four-sided fence with self-latching gates that is at least four feet high to separate the pool area from the house, and consider installing an alarm.
Throughout the year, we will be highlighting NTDB data through brief reports in the Bulletin. The NTDB 2013 Pediatric Report is available on the ACS website. In addition, information on how to obtain NTDB data for more detailed study is posted on the site. If you are interested in submitting your trauma center’s data contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org.
Acknowledgement
Statistical support for this article has been provided by Chrystal Caden-Price, Data Analyst, and Alice Rollins, NTDB Coordinator.
*The U.S. Geological Survey Water Science School. Water basics: How much water is there on, in, and above Earth? Available at: http://water.usgs.gov/edu/earthhowmuch.html. Accessed May 20, 2014.
†World Health Organization. Media centre: Drowning fact sheet. Available at: http://www.who.int/mediacentre/factsheets/fs347/en/. Accessed May 20, 2014.
‡Centers for Disease Control and Prevention: Home and recreation safety. Unintentional drowning: Get the facts. Available at: http://www.cdc.gov/homeandrecreationalsafety/water-safety/waterinjuries-factsheet.html. Accessed May 20, 2014.
