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PubMed2005

Pediatric drowning: a 20-year review of autopsied cases: I. Demographic features.

Drowning is a significant cause of childhood mortality in the developed world. Males and preschool-aged children are overrepresented in most series of pediatric drowning. To obtain a better understanding of age- and gender-related factors, a retrospective review of autopsy records over a 20-year period (1984-2003) for cases of drowning (exclusive of bathtub drownings) was performed. Sixty-three consecutive cases of drowning were identified in 45 males and 18 females (ratio 2.5; P = 0.0007). The ages ranged from 9 months to 17 years, and most cases occurred in the 0- to 4-year age group (57%). Boys tended to be older than girls (5 years 9 months versus 4 years 4 months; P = 0.2133). Sites of drowning were open water (48%) and pools (44%), with children drowning in open water being significantly older than those drowning in pools (6 years 6 months versus 4 years 6 months; P = 0.0462). Most boys drowned in open water (53%), whereas most girls drowned in pools (50%). Resuscitation was attempted after the drowning episode in 84% of cases, with children aged 4 years or less having significantly higher rates than older children (P = 0.0346). The present study highlights differences in the pattern of drowning according to age and sex and may aid in developing targeted educational and preventative campaigns.

Adolescent↗
PubMed1990

Plasmatic levels of atrial natriuretic peptide (ANP) in drowning. A pilot study.

Bodies found in water may cause problems for forensic pathologists who have to differentiate drowning from postmortem immersion or fresh from salt water drowning. The exact physiopathology of drowning is still controversial and complementary tests can not exactly establish the exact cause of death if macroscopic findings at autopsy are not conclusive. We have employed atrial natriuretic peptide (ANP) as a marker in an experimental series of fresh and salt water drowning, comparing their results with a non-drowned control series. There are differences between the plasma basal levels of the control series (79 pg/ml) and the levels in animals drowned in fresh water (358 pg/ml, P less than 0.001) and between control and rabbits drowned in salt water (190 pg/ml, P less than 0.001). According to these values, there are also differences between fresh and salt water drowned animals (P less than 0.001). We propose this peptide as a new marker in cases of drowning, with the ability to differentiate drowning from postmortem immersion and fresh from salt water drowning.

Analysis of Variance↗
PubMed2003

Children under 5 years presenting to paediatricians with near-drowning.

OBJECTIVE: To characterize children aged under 5 years who present to paediatricians following near-drowning and the circumstances surrounding the event, identify high-risk groups and document short-term outcome. METHODOLOGY: Monthly notifications to the Australian Paediatric Surveillance Unit (an active, national surveillance system) between 1994 and 1996. Collection of additional case information from reporting doctors by postal questionnaire. RESULTS: All 169 reported cases of near-drowning were admitted to hospital (mean (SD) stay 6 (17) days) and 15% required intensive care (mean (SD) stay 19 (32) days). The mean (SD) age for near drowning was 26 (13) months and 22% children were aged between 12 and 18 months. Males predominated (1.6:1) and 69 (41%) of episodes occurred in summer (December - February). The majority (82%) of near-drownings occurred in the child's home, usually in a swimming pool or bath. Children who nearly drowned at home were significantly younger than those who nearly drowned in natural waterways or public pools. Neurological damage at discharge following near-drowning was reported in 7%. CONCLUSIONS: Children reported in this national case series represent the severe end of the spectrum of those who nearly drown, as indicated by their presentation to a paediatrician, universal hospitalization and adverse neurological outcome. The home is the site of most near-drownings and males and toddlers were at particular risk. Unimpeded access to pools and lack of supervision were identified as potentially modifiable factors for prevention. The study suggests the need for additional community education regarding the risks of near-drowning and for further research on long-term neuro-developmental outcomes following near-drowning.

Age Factors↗
PubMed2004

Alcohol and drowning in Australia.

OBJECTIVES: To examine the contribution of alcohol to drowning deaths in Australia. METHODS: Drowning deaths that occurred in Australia (excluding Queensland) from 1 July 2000 to 30 June 2001 were identified using the National Coroners Information System (NCIS). The current analysis was based on those deaths for which the Coronial process was completed by March 2003 ('Closed' cases). Comparison was made with the Australian Bureau of Statistics (ABS) national deaths data and with currently used values of attributable fractions for alcohol and drowning in Australia (these values are based on USA data on drownings from 1980 to 1984). RESULTS: 289 drowning deaths were identified, 5% less than comparable ABS data. Of these deaths, 240 were 'Closed' cases, and valid blood alcohol measurements were available for 137 (58%) of these. Alcohol appeared to contribute to approximately 19% of these fatal drowning incidents (25% for recreational aquatic activity; 16% for incidental falls into water; 12% for drowning due to suicide). Using > or = 0.10 g/100 ml as the cut-off, the estimated all-ages proportions of unintentional drowning attributed to alcohol was 17% in the current study, compared to the 34% currently used for Australia based on data from North America. CONCLUSIONS AND IMPLICATIONS: A high level of alcohol appears to be present less frequently among recent drowning deaths in Australia than has been assumed to be the case to date. Nevertheless, many drowning victims have high levels of blood alcohol, and public health efforts to minimize the use of alcohol in association with activity on or near water should be continued. Despite some deficiencies, the NCIS appears to be a very useful source of information on public health issues, and to provide a better basis for assessing and monitoring alcohol-related drowning deaths in Australia than the published attributable fractions used to date.

Accidental Falls↗
PubMed1988

Drowning mortality in Los Angeles County, 1976 to 1984.

Drowning is the fourth leading cause of unintentional injury death in Los Angeles County. We examined data collected by the Los Angeles County Coroner's Office on drownings that occurred in the county from 1976 through 1984. There were 1587 drownings (1130 males and 457 females) during this nine-year period, for an annual rate of 2.36 drownings per 100,000 persons (3.44 for males and 1.33 for females). The largest proportion of drownings (44.5%) for both sexes, and in almost every age group, occurred in private swimming pools. Children 2 to 3 years of age had the highest swimming-pool drowning rate (7.95). The elderly also experienced high drowning rates, primarily in swimming pools and bathtubs. Drowning-site profiles varied dramatically by age and sex. These findings indicate a need for Los Angeles County to address the problem of drownings among infants and toddlers in private swimming pools and to investigate the failure of regulations requiring fencing of swimming pools to prevent these deaths. These findings also suggest several potential opportunities for preventive intervention by physicians and demonstrate that health professionals cannot rely on national drowning-site profiles when developing local drowning prevention strategies.

Adolescent↗
PubMed2006

Swimming pool drownings among US residents aged 5-24 years: understanding racial/ethnic disparities.

OBJECTIVE: We examined circumstances surrounding swimming pool drownings among US residents aged 5 to 24 years to understand why Black males and other racial/ethnic groups have high drowning rates. METHODS: We obtained data about drowning deaths in the United States (1995-1998) from death certificates, medical examiner reports, and newspaper clippings collected by the US Consumer Product Safety Commission. RESULTS: During the study period, 678 US residents aged 5 to 24 years drowned in pools. Seventy-five percent were male, 47% were Black, 33% were White, and 12% were Hispanic. Drowning rates were highest among Black males, and this increased risk persisted after we controlled for income. The majority of Black victims (51%) drowned in public pools, the majority of White victims (55%) drowned in residential pools, and the majority of Hispanic victims (35%) drowned in neighborhood pools (e.g., an apartment complex pool). Foreign-born males also had an increased risk for drowning compared with American-born males. CONCLUSIONS: Targeted interventions are needed to reduce the incidence of swimming pool drownings across racial/ethnic groups, particularly adult supervision at public pools.

Adolescent↗
PubMed1994

Child and adolescent drownings in Harris County, Texas, 1983 through 1990.

OBJECTIVES: This study described childhood drowning rates and circumstances in Harris County, a large metropolitan area in Texas, and compared case ascertainment between data sources. METHODS: Drowning rates among Harris County residents newborn through 19 years of age were calculated from death certificate data (1983 through 1989), and local childhood drowning hazards were described on the basis of medical examiner data (1983 through 1990). Cases from both sources were compared to determine sensitivity of sources. RESULTS: The drowning rate among Harris County residents newborn through 19 years of age was 3.8 per 100,000 person-years. The drowning rates among Blacks and Hispanics exceeded that of Whites by 56% and 19%, respectively. The majority of the 196 unintentional drownings occurred in swimming pools. Half of the pool drownings occurred in apartment pools and 33% in private home pools. The medical examiner logbook identified a slightly higher number of drownings than did death certificates. International Classification of Diseases external cause of death codes were of limited use in describing drowning circumstances. CONCLUSIONS: Childhood drowning hazards not previously reported were identified, specifically hazards in apartment pools and those among Hispanic children.

Adolescent↗
PubMedDate not supplied

Childhood drowning in New South Wales 1990-1995: a population-based study.

OBJECTIVE: To review the circumstances of children drowning in New South Wales (NSW), 1990-1995, and to analyse trends. DESIGN: The NSW Paediatric Trauma Death Review Data Unit received coronial notification of childhood drowning deaths. Age-specific annual drowning rates per 100,000 population were calculated. SUBJECTS: Children aged 0-14 years who died of drowning. RESULTS: 132 children drowned (96[73%] aged 0-4 years). There was was an overall decrease in incidence of drowning, from 2.0 to 1.5 per 100,000 population, and a decline in domestic pool drownings (from a peak of 15 in 1992 to five in 1995), and in drownings in waterways (from nine to six over the six-year period). However, drownings in baths and dams did not decrease. In general, boys were at higher risk than girls. CONCLUSIONS: Analysis of the drowning incidents indicates that, despite the decreases documented, we should not be complacent, and preventive programs are still warranted. All pools and dams should have well maintained fences between the body of water and the house. All infants aged under three and all epileptic children should be supervised in the bath by an adult. Children should be taught to swim, warned of the dangers of rivers and surf, and adequately supervised.

Adolescent↗
PubMed2001

Drowning-related deaths in New Zealand, 1980-94.

OBJECTIVE: To describe the epidemiology of drowning in New Zealand for the period 1980-94. METHODS: Drowning-related incidents were identified by linking New Zealand Health Information Service and Water Safety New Zealand databases. RESULTS: 2,606 drowning-related incidents were identified. In three-quarters of the incidents, drowning was listed as the immediate cause of death. The majority of drownings were unintentional (85%), involved males (76%), and 0-4 and 15-24 year age groups had the highest rates. Boating was the leading cause of unintentional drowning (28%) followed by swimming and other water sports (19%), motor vehicle drownings (13%) and falls or slips (12%). CONCLUSIONS AND IMPLICATIONS: Although there has been a significant decline in drownings, New Zealand compares poorly internationally. In particular, our unintentional drowning rate is twice that of Australia. For New Zealand to continue to make substantial progress in addressing its overall drowning rate, we need to continue and strengthen our efforts in priority areas, in particular those due to motor vehicle crashes and boating and among pre-schoolers, adolescents and young adults. Motor vehicle traffic crashes warrant closer attention than has been the case to date.

Accidents↗
PubMedDate not supplied

Activities associated with drownings in Imperial County, CA, 1980-90: implications for prevention.

Statewide surveillance in California determined that the highest drowning rate from 1980 through 1989 was for the rural, desert county of Imperial (21.9 drownings per 100,000 population). To identify activities associated with drowning in this county, the authors abstracted data from the county sheriff-coroner's reports. From 1980 through 1990, there were 317 unintentional drownings; 85 percent occurred in irrigation canals. The activity prior to drowning was known for 262 persons (83 percent), and the most common activity was illegal entry into the United States. Overall, 140 persons (53 percent) were illegal entrants. Ninety-three percent of illegal entrants drowned in the All American Canal; the monthly drowning rate increased as the monthly average water velocity in the canal increased (r = 0.36; P < 0.001). Forty-eight persons (18 percent) drowned while riding in or on a land vehicle (automobile, pick-up truck, motorcycle, dune buggy, or tractor), the second most common activity associated with drowning. Seventy percent of the 23 drivers had an alcohol concentration of 100 milligrams per deciliter or more, California's limit for intoxication. To reduce drownings in Imperial County, prevention strategies should target persons engaged in at-risk activities near bodies of water. These strategies should include the identification and use of effective canal safety devices.

Accidents, Traffic↗
PubMed1993

Covert suicide among elderly Japanese females: questioning unintentional drownings.

A hypothesis is generated that despite high reported rates, suicide among elderly Japanese females is substantially underestimated due to misclassification of drowning suicides (ICD-9 E954) as unintentional drownings (ICD-9 E910). Data are adapted from 1979-1981 age-, sex- and cause-specific mortality tabulations for Japan, the United States, Australia, France, New Zealand, Norway, Sweden and the United Kingdom. Between ages 55 and 74 years, unintentional drowning rates for males and females in Japan begin to diverge sharply from those of comparison countries. By ages 75 and older, the rate for Japanese females is 13.5 per 100,000, which exceeds comparison rates by 7- to 15-fold. Although drowning suicide rates in this population are also high, its ratio of drowning suicides to unintentional drownings declines precipitously beyond ages 35-44. Excess drowning suicide underestimation among Japanese females is suggested by the absence of a similar change among the males and evidence of both a lack of drowning witnesses and sex differentials in life expectancy, living arrangements and suicide methods. A preliminary test of the drowning suicide hypothesis is proposed which incorporates psychological autopsies.

Adolescent↗
PubMed1995

A canine study of cold water drowning in fresh versus salt water.

OBJECTIVE: To compare the pathophysiologic changes occurring during drowning in cold fresh water and cold salt water with reference to viability. DESIGN: Randomized, prospective, controlled submersion experiments in two contrasting cold liquids. SETTING: A laboratory at a large university-affiliated medical institution. SUBJECTS: Thirteen healthy, anesthetized mongrel dogs. Three dogs served as controls and were immersed but not submerged. The remainder were submerged in cold fresh water or cold salt water (4 degrees C). INTERVENTIONS: Catheters were placed in the femoral artery, right carotid artery and right internal jugular vein. Electrocardiogram, pneumogram, and rectal temperatures were measured continuously during submersion/immersion. MEASUREMENTS AND MAIN RESULTS: Cold water submersion with drowning produced a large initial decrease in carotid artery temperature (approximately 7.5 degrees C in the first 2 mins) compared with a minor decrease (approximately 0.8 degrees C with immersion). No significant differences were noted in the rate of decrease of temperature between drowning in fresh water and salt water. During cold fresh water drowning, aspiration produced gross hemodilution with an average increase in body weight of 16.5%. Hematocrit values, serum sodium concentrations, and osmolality decreased while serum potassium concentrations, catecholamines, and free hemoglobin increased. All measured biochemical data (except PaO2) remained at viable levels. By contrast, during cold salt water drowning, average body weight increased by only 6%, with hemoconcentration and a shrinkage of vascular volume. Hematocrit and hemoglobin values increased by 30%, but initial plasma free hemoglobin values remained unchanged. Serum sodium concentrations, osmolality, and potassium concentrations increased rapidly to critical levels. CONCLUSIONS: On submersion in cold water, all of the experimental animals developed tachypnea immediately, followed by aspiration with predictable effects. The biochemical and pathophysiologic changes in cold water drowning approximated those changes reported for warm water drowning for both fresh and salt water with one exception and continued aspiration of cold water produced extremely rapid core cooling as long as the circulation remained intact. This process of acute submersion hypothermia may protect the brain temporarily from lethal damage, as reported in cases of cold fresh water drowning. Concentrations of circulating catecholamines increased exponentially in both groups of test animals. Clinically, their acute effects on the circulation, compounded by significant hypothermia and extreme anoxia, must hamper the detection of residual circulation at rescue and may play a role in sudden death from cold water in the absence of drowning.

Animals↗
PubMed2005

Drowning of babies in bath seats: do they provide false reassurance?

AIMS: To investigate the problem of children drowning in bath seats by examining case reports, by looking at the epidemiology of bath drowning in children under two years of age and by reviewing the literature. METHODS: We describe two babies: one who drowned and one nearly drowned in the bath whilst in a bath seat. We examined the RoSPA/RLSS UK database of cases of children under two years drowning in the bath for the years 1989-2003. Cases are ascertained through a press cutting system. We conducted an all language literature search of original articles, references, textbooks and conference abstracts 1951-October 2004 in 11 standard databases. RESULTS: The two cases illustrate how parents can have a false sense of security with bath seats. We found six cases of babies under two years drowning in the UK associated with bath seats in the time period 1989-2003. They were all boys: five of the six were under one year of age. This compared with 47 children of similar age drowning in the bath not associated with a bath seat. The literature is sparse with only four papers since 1966. DISCUSSION: A baby drowning after being placed in a bath seats is a rare but definite cause of death. Bath seats appear to give a false sense of security (even if not encouraged by the manufacturers). It is unclear whether putting a baby in a bath seat represents an increased risk of drowning compared with a baby without a seat. Without knowing the numbers of mothers that use bath seats it is difficult to come to firm conclusions on the risks to babies. New research is needed to clarify this issue. Whether in a seat or not it is clear that the main risk to babies in the bath is being left unsupervised.

Drowning↗
PubMed1991

Outcome in children who nearly drown: a British Isles study.

OBJECTIVE: To determine the outcome in nearly drowned children in the British Isles and identify factors that might predict a poor prognosis. DESIGN: Study of drowned and of nearly drowned children aged less than or equal to 14. Information on nearly drowned children admitted to hospital obtained from consultant paediatricians returning monthly notification cards through the British Paediatric Surveillance Unit. Information on drowned children obtained from Office of Population Censuses and Surveys and other national epidemiological offices. SETTING: British Isles, 1988 and 1989. SUBJECTS: 330 children who had confirmed submersion incidents. 142 died before admission to hospital and 188 children were admitted after nearly drowning. MAIN OUTCOME MEASURES: Death, full recovery, or degree of handicap after near drowning and signs on admission to hospital. RESULTS: All of the children who were conscious on admission fully recovered. Of the 64 children unconscious on admission, 31 had normally reactive pupils and all but three (all of whom had severe preexisting neurological disease) recovered fully. Of the 33 children with fixed dilated pupils on admission, 10 fully recovered, 13 died, and 10 had severe neurological deficit. Spontaneous respiratory effect on admission was associated with normal survival. Pupils that remained dilated six hours after admission and fits continuing 24 hours after admission predicted a poor outcome. CONCLUSION: Children can survive normally after near drowning in the British Isles, particularly if they have been hypothermic. Resuscitation should not be abandoned in nearly drowned children until they have been rewarmed.

Adolescent↗
PubMed2001

Alcohol and other risk factors for drowning among male active duty U.S. army soldiers.

BACKGROUND: Risk factors for drowning are largely undocumented among military populations. HYPOTHESIS: Accident report narratives will provide important information about the role of alcohol use and other behaviors in drownings among active duty male U.S. Army soldiers. METHODS: Using a case series design, we describe drowning deaths reported to the U.S. Army Safety Center (1980-1997), documenting associated demographic factors, alcohol use, and other risk-taking behaviors. RESULTS: Drowning victims (n = 352) were disproportionately young, black, and single, with less time-in-service, and no college experience. Most drownings occurred off-duty (89%). Alcohol use was involved in at least 31% of the cases overall. Alcohol use was also associated with a 10-fold increase in reckless behavior (OR 9.6, 95% Cl 4.5-20.7) and was most common among drownings in Europe (OR = 4.3, 95% Cl 1.5-13.4). Most drownings occurred where no lifeguard was present (68%), but almost two-thirds occurred in the presence of others, with CPR initiated in less than one-third of these cases. Drownings involving minority victims were less likely to involve alcohol, but more likely to occur in unauthorized swimming areas. While most drownings did not involve violations of safety rules, over one-third of the cases involved some form of reckless behavior, particularly for those under age 21. CONCLUSIONS: Intervention programs should be tailored to meet the needs of the demographic subgroups at highest risk since behavioral risk factors vary by race and age. CPR training and skills maintenance can improve survival rates. Narrative data are important for developing hypotheses and understanding risk factors for injuries.

Adolescent↗
PubMed2003

The role of bath seats in unintentional infant bathtub drowning deaths.

OBJECTIVE: The objective of this study was to quantify and characterize the role of bath seats in infant mortality from bathtub drowning. METHOD: Risk analysis of bathtub drowning deaths for infants aged 6-10 months was performed using data available from the US Consumer Product Safety Commission (CPSC), birth and mortality data from the National Center for Health Statistics (NCHS) for US resident infants from 1990-1998, and bath seat ownership from the American Baby Group and industry sales data compiled by NPD to estimate bath seat use. The analysis computes the relative risks of infant drowning based on estimates of bath seat use with a cohort design and explores the potential confounding by a range of factors. RESULTS: In-depth analysis of the unintentional bathtub drowning deaths of American infants aged 6-10 months for the years 1994 through 1998 revealed 40 infant drowning deaths associated with bath seats and 78 deaths not associated with bath seats. Based on available data on sales and use that suggest approximately 45% of infants in this age group use bath seats, the existing data do not support a hypothesis that bath seats increase the risk of bathtub drowning for infants. Bath seats are not intended or marketed as safety devices, and analysis of the existing, albeit limited, data suggests that they either have no effect or they may provide some slight unexplained protection against unintentional bathtub drowning risks (with an odds ratio for the risk of drowning with a bath seat vs without a bath seat of approximately 0.6 [95% confidence interval (CI) 0.4-0.9]). Although all potential confounders cannot be fully explored due to incomplete data and large uncertainties remain, this analysis suggests that the US CPSC made the appropriate decision not to ban bath seats in response to petitions it received in 1994 and 2001. CONCLUSIONS: Increasing market sales and surveys of reported bath seat use were associated with decreasing unintentional infant bathtub drowning risks. Rigorous risk analyses should be conducted when considering regulating products to ensure that regulation does not inadvertently increase injury risks. Analysis of the factors associated with these deaths suggests that additional efforts are needed to ensure that caregivers do not leave infants unattended in the bathtub and to collect data that will further improve our understanding and management of these risks.

Age Factors↗
PubMed2003

[Place of pathology in the forensic diagnosis of drowning].

The diagnosis of drowning is one of the most difficult in forensic pathology. Drowning is death through the aspiration of fluid into the air passages. Signs of immersion only demonstrate submersion of the body for a period of time but are not signs of drowning. The best signs of drowning are froth around the mouth and nostrils and lung distension. Lung histology in drowning victims shows non-specific lesions such as "emphysema aquosum" and alveolar edema. The diatom test for drowning requires a careful protocol to avoid possible contamination. Sample collection (cardiac blood, lung, liver, kidney tissue, bone marrow and brain) should be performed during the first part of the autopsy. Sample preparation requires chemical or enzymatic digestion. The diatom test should be both qualitative and quantitative. Species recovered from the body must correspond to those from the site of drowning and approximately in the same proportions. The diatom test has poor sensitivity and thus is much debated because it is always difficult to rule out possible contamination. Moreover, a negative diatom test cannot rule out drowning as the cause of death. The diagnosis of drowning is based on police investigations, forensic autopsy, microscopic analysis, and biochemical tests, but never solely on pathology findings.

Autopsy↗
PubMed1992

Drownings in a private lake--North Carolina, 1981-1990.

Drowning is the third most common cause of death from unintentional injury in the United States (1); in 1989, in North Carolina, drownings were the leading cause of years of potential life lost before age 65 per death (2). From July 1 through August 31, 1990, two drownings occurred in a private lake in Beaufort County (1990 population: 42,283), North Carolina. A review of data from the Office of the Chief Medical Examiner (OCME) in North Carolina identified two additional drownings at this lake during 1981-1990, and a total of 17 drownings in the county during the 10-year period. At the request of the local health director, in October 1990, the North Carolina Department of Environment, Health, and Natural Resources (DEHNR) investigated the drownings using information from OCME files, hospital medical records, and ambulance reports. This report summarizes the investigation of the four drownings in the private lake, recommendations to prevent additional drownings, and characteristics of drownings in North Carolina in 1989.

Adolescent↗