Research Review: Trends in US Pediatric Drowning Hospilatization

ILS Drowning Prevention Commission Member – Dr Richard Franklin reviews research recently published in Pediatrics, the official Journal of the American Academy of Pediatrics. The review of this paper titled, trends in US Pediatric Drowning Hospitalizations 1993-2008, is a component of the ILS commitment to promoting, sharing and linking research to policy and practice.

Dr Richard Franklin writes:

The recently released article by Bowman, Aitken, Robbins and Baker explores trends in US Pediatric Drowning Hospitalizations for the period 1993 – 2008. It provides a longitudinal examination of hospitalized cases of drowning in children 0-19 years. Over the studies 17 year period, there was a 51% decrease in the number of children hospitalized due to drowning, from 1993 (3623) and in 2008 (1,781).

While the decreases were across all age groups, the 0-4 year age group had the most dramatic drop, from 12.7 per 100,000 in 1993-1994 down to 5.6 per 100,000 in 2007-2008. The study also explores the use of International Classification of Disease (ICD) version 9 codes.

The Authors compare drowning rates in 1998-1999 and 2007-2008 by age, gender and ICD classifications. There are some interesting trends apparent, with the decreases not statistically signficant in all age categories. This section makes for thought provoking reading.

The days in hospital also decreased, however the overall cost remained reasonably constant at around the $50million mark per annum. The Authors noted that the large decreases were due in part to decreases in the South and Midwest areas of the US.

In the discussion section, the authors provide a range of explanations for the decrease in hospitalizations for child drowning. Explanations include greater supervision during bath time. They were unable to determine if overall the neurologic function of the children who survive had changed, but did find that while the fatal rate did decrease (0.5 to 0.3), it was the non fatal rates where the biggest decreases were seen (4.2 to 2.1).

While the authors mention that better decision making in the pre-hospital period may be resulting in the declaration of some drowning deaths prior to hospital, I also think that this may impact the number of non-fatal cases presenting at hospital.

One of the other interesting points made is the observation by the authors that the decrease may be explained by a trend towards swimming at supervised water locations i.e. swimming pools with lifeguards and away from open water ways such as rivers and lakes. This warrants further investigations.

The article can be found at http://pediatrics.aappublications.org/content/129/2/275.full.pdf+html

Dr Richard Franklin

Anyone wishing to contribute similar research reviews are encouraged to contact Justin Scarr ILS Drowning Prevention Commissioner, jscarr@rlssa.org.au.