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Drowning

Drowning is defined as death resulting from suffocation within 24 hours after submersion in water. Non-fatal submersions are classified as near-drownings and are defined as survival for at least 24 hours after suffocation from submersion in water. [1] Most drownings occur in places other than the home environment; these drownings include all those associated with boating and open water. Of the drownings that occur in the home environment, 80% are children ages 4 and under, and most of these occur in home swimming pools and bathtubs. [2] While drowning rates have slowly declined over the past 20 years, drowning remains the second-leading cause of injury-related death for children ages 1 to 14 years. [3] While many promising drowning interventions have not been proven in scientific studies, four-sided fencing around home swimming pools has been proven effective in preventing drowning among children. [1, 2, 4]

Morbidity and mortality

Deaths

  • Drownings are the fifth leading cause of home injury death in the United States, accounting for an average of 823 deaths per year. [1]
  • Drowning is the second leading cause of unintentional injury-related death among children ages 1 to 14. [2, 5]
  • Drowning is the leading cause of unintentional injury related death among children ages 1 to 4. [2]
  • The death rate for drowning is highest among children younger than 5, lowest among adolescents and adults, and increases among those age 70 and older. [1]
  • About one-fourth of all drownings occur in the home or surrounding premises. [1]

Injuries and Emergency Room Visits

Near-drownings have very high case fatality rates. Fifteen percent of children admitted for near-drowning die in the hospital, and as many as 20% of survivors suffer severe, permanent neurological disability. [2] An average of 7,171 near-drowning injuries, resulting in an emergency department visits, occur in the home environment every year in the United States. [1] It is estimated that between 1 and 4 near-drownings serious enough to result in hospitalization occur for each drowning-related death. [6]

Where and when the deaths and injuries occur

  • One third of unintentional home drownings occur in bathtubs, 18% occur in unspecified locations and almost half of unintentional home drownings (45%) occur in other locations including swimming pools. [1]
  • More than half of drownings among infants (under age 1) occur in bathtubs. Another 12% of drowning in this age group occur in buckets. More than half of drownings among children ages 1 to 4 are pool related. Children ages 5 to 14 most often drown in open water sites. [2, 3, 6]
  • An estimated 30 children drown in buckets every year. [2]
  • Among children ages 4 and under, there are approximately 300 residential swimming pool drownings each year. More than half of these drownings occur in the child's home pool, and one third occur at the homes of friends, neighbors and relatives. [2]
  • Most children who drown in swimming pools were last seen in the home, had been missing from sight for less than five minutes, and were in the care of one or both parents at the time of the drowning. [2, 3]
Populations at disproportionate risk
  • Children under age 5 have the highest drowning death rate (two to three times greater than other age groups). [1, 2]
  • Male children have a drowning rate two to four times that of female children. However, female children have a bathtub drowning rate twice that of males. [1, 2]
  • African American males ages 5 to 9 have a swimming pool related drowning rate 4 ¬Ĺ times that of their Caucasian counterparts. African American males ages 10 to 14 have a swimming pool related drowning rate 15 times that of their Caucasian counterparts. [2]
  • Children from low income households are at greater risk from non swimming pool drownings. [2]
Effectiveness of injury interventions
  • Installation of four-sided fencing around home swimming pools is the only intervention that has been proven effective in preventing drowning of young children. The fencing should include a self-closing and self-latching gate. [1, 2, 4]
  • The US Consumer Product Safety Commission has developed voluntary guidelines, which include education and labeling, to address the hazard of children drowning in five-gallon buckets. However, these guideline have not been evaluated for effectiveness. [2]
  • Evaluation of other drowning interventions have focused on boating safety and use of personal flotation devices, which are not applicable to drowning risks in the home environment. [2, 3]
Cost and cost-effectiveness data
  • The medical costs of unintentional home drownings average $2 billion annually. [1]
  • Typical medical costs for a near-drowning victim can range from $75,000 for initial emergency room treatment to $180,000 a year for long-term care. The cost of a single near-drowning that results in brain damage can be more than $4.5 million. [2]
References
  • 1. Runyan, C. and C. Casteel, eds. The State of Home Safety in America: Facts About Unintentional Injuries in the Home. 2nd ed. 2004, Home Safety Council: Washington, DC.
  • 2. National SAFE KIDS Campaign. Drowning fact sheet. 2004, National SAFE KIDS Campaign: Washington, DC.
  • 3. National Center for Injury Prevention and Control. Water-related injuries: fact sheet. 2005. http://www.cdc.gov/ncipc/factsheets/drown.htm. Accessed on October 20, 2005.
  • 4. Thompson, D.C. and F.P. Rivara. Pool fencing for preventing drowning in children. Cochrane Database of Systematic Reviews, 1998, Issue 1. Art. No.: CD001047. DOI: 10.1002/14651858.CD001047.
  • 5. National Center for Injury Prevention and Control. Web-based injury statistics query and reporting system (WISQARS). 2005. http://www.cdc.gov/ncipc/wisqars. Accessed on August 31, 2005.
  • 6. Brenner, R. Technical report: prevention of drowning in infants, children and adolescents. Pediatrics, 2003. 112: p. 440-445.
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