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PEDIATRICS Vol. 83 No. 6 June 1989, pp. 1035-1040
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Ten-Year Study of Pediatric Drownings and Near-Drownings in King County, Washington: Lessons in Injury Prevention

Linda Quan MD1, Edmond J. Gore PhD1, Kim Wentz MD1, Jill Allen MD1, , Alvin H. Novack MD1

1 The Departments of Pediatrics and Psychology, University of Washington School of Medicine, and the Department of Epidemiology, School of Public Health, University of Washington, Seattle

The factors associated with submersion events among <20-year-old persons that occurred in King County from 1974 to 1983 were studied to focus prevention efforts. Near-drowning (n = 103) and drowning (n = 96) victims were identified from medical examiners' reports, paramedics' reports, and hospital discharge registers. Annual incidence was 5.5; the mortality rate was 2.6 per 100,000 children. Although preschool-aged children had the largest incidence (12.8), followed by older adolescents (4.9), adolescents had the largest case fatality rate, 77%. Lake and river victims had the largest incidence, mortality, and case fatality rate; swimming pools, the smallest case fatality rate (25%). A total of 89% of all victims had absent or no supervision; victims supervised by lifeguards had a 42% case fatality rate. Prior seizures were part of the history of 7.5% of all victims; 25% of fatal submersions by adolescents were associated with alcohol. Bathtub submersions were associated with child abuse in three of 16 preschool-aged children and epilepsy in four of five older children. Certain age groups and sites combined had the greatest incidence: preschool-aged children in swimming pools, infants in bathtubs, teenagers in lakes and rivers. Incidence decreased in public and semipublic pools coincident with fencing regulations. These findings suggest prevention strategies: extending fencing requirements to private pools, discouraging alcohol consumption during water sports, changing bathing practices of epileptics, and improving lifeguard efficacy.

Key Words: submersion • drowning • near-drowning • injury prevention

Submitted on August 9, 1988
Accepted on December 2, 1988


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