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Vivian Hwang, MD; Frances S. Shofer, PhD; Dennis R. Durbin, MD, MSCE; Jill M. Baren, MD

Arch Pediatr Adolesc Med. 2003;157:50-53.

Objective  To determine the prevalence of traumatic injuries in children involved in drowning and near-drowning accidents.

Design/Methods  Ten-year retrospective medical chart review of patients at an urban tertiary care pediatric facility. Included patients had International Classification of Diseases, Ninth Revision, Clinical Modification codes for fatal/nonfatal drowning or E codes for fall into water, accidental drowning, and submersion. We recorded demographics, event characteristics, diagnostics, and outcome data. We used the ² or the Fisher exact test to compare patients with and without injuries.

Results  One hundred forty-three patients met inclusion criteria. Of these, 95 (66.4%) were male. Median age was 3.8 years, and 30 (23.4%) of 128 had preexisting conditions. Site of drowning was the pool (70.6%), the bathtub (19.0%), or natural water (10.4%). The prevalence of traumatic injury was 4.9% (95% confidence interval, 0%-28%). The predominant mechanism of injury was diving, and all injuries were to the cervical spine. Patients with injury were more likely to be older (mean age, 13.5 vs 5.1 years; P<.001) and to have a history of diving (85.7% vs 2.2%; P<.001). The presence of injury was not associated with sex, preexisting condition, or site of drowning (P>.05).

Conclusions  The prevalence of traumatic injury in drowning and near drowning is low. We identified only cervical spine injuries, and all but 1 patient had a clear history of diving. Use of specialized trauma evaluations may not be warranted for patients in drowning and near-drowning accidents without a clear history of traumatic mechanism.

From the Department of Emergency Medicine, Hospital of the University of Pennsylvania (Drs Hwang, Shofer, and Baren), the Division of Emergency Medicine, The Children's Hospital of Philadelphia (Drs Hwang, Durbin, and Baren), and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania (Dr Durbin), Philadelphia.

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