Epidemiology of paediatric drowning hospitalisations in the USA: a population-based study

Abstract

BackgroundDrowning is a leading cause of death in children ≤5 years old. Detailed data on the epidemiology of drowning in this high-risk population can inform preventative efforts. We aimed to study trends in incidence and case fatality rates (CFR) in the USA among young children hospitalised after drowning.MethodsChildren ≤5 years old hospitalised in the USA after drowning were identified from the Kids Inpatient Database 2000–2016. Incidence and CFRs by calendar year, age, sex, race/ethnicity and hospital region were calculated. Trends over time were evaluated. Factors associated with fatal drowning were assessed.ResultsAmong 30 560 804 hospitalised children ≤5 years old, 9261 drowning cases were included. Patients were more commonly male (62.3%) and white (47.4%). Two years old had the highest incidence of hospitalisation after drowning, regardless of race/ethnicity, sex and region. Overall drowning hospitalisations decreased by 49% from 2000 to 2016 (8.38–4.25 cases per 100 000 children). The mortality rate was 11.4% (n=1060), and most occurred in children ≤3 years old (83.0%). Overall case fatality decreased between 2000 and 2016 (risk ratio (RR) 0.44, 95% CI 0.25 to 0.56). The lowest reduction in incidence and case fatality was observed among Black children (Incidence RR 0.92, 95% CI 0.75 to 1.13; case fatality RR 0.80, 95% CI 0.41 to 1.58).ConclusionsHospitalisations and CFRs for drowning among children ≤5 years old have decreased from 2000 to 2016. Two years old are at the highest risk of both fatal and non-fatal drowning. Disparities exist for Black children in both the relative reduction in drowning hospitalisation incidence and case fatality. Interventions should focus on providing equitable preventative care measures to this population.

Individual, environmental and demographic factors may play a role in the prognosis of fatal and non‐fatal paediatric drowning

“…1,5,6,10,14,26 Given that the initial response to a drowning event typically begins with layperson involvement, there is a need to improve the primary response to such incidents by providing widespread training and education on BLS and CPR. 1,10,14,15,20,24,25 Finally, we did not identify any environmental, demographic or individual risk factors associated with a significant increase in length of hospital stay. Only the need for CPR (p = 0.053) and trauma (p = 0.02) were associated with longer hospitalisation, suggesting a more complex clinical course (Table 2).…”

“…While there is a consensus on the importance of providing swimming lessons to all children, the optimal age for starting these, lessons remains a subject of debate 9,13,15,20 . Specifically, it is unclear whether early swimming lessons before the age of 4 can offer protective benefits or pose a risk by making children overconfident and potentially reckless 9,13,15,20 …”

“…Given that the initial response to a drowning event typically begins with layperson involvement, there is a need to improve the primary response to such incidents by providing widespread training and education on BLS and CPR 1,10,14,15,20,24,25 …”

“…1,3,[16][17][18][19] While there is a consensus on the importance of providing swimming lessons to all children, the optimal age for starting these, lessons remains a subject of debate. 9,13,15,20 Specifically, it is unclear whether early swimming lessons before the age of 4 can offer protective benefits or pose a risk by making children overconfident and potentially reckless. 9,13,15,20 We believe that early inclusion in swimming programmes, starting within the first years of life, as it occurs in Liguria region, can play a protective role by teaching children swimming skills, instilling confidence and fostering familiarity with bodies of water.…”

Unintentional Drownings in Pediatric Populations: Injury Prevention in the Post-COVID-19 Era

“…Similar findings were reported by Theodorou et al from the University of California, Davis, where hospitalizations after drowning were assessed using the Kids Inpatient Database between 2000-2016. They found overall drowning hospitalizations decreased by 49% during this time period [ 7 ].…”