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Epidemiology of paediatric drowning hospitalisations in the USA: a population-based study
  1. Christina M. Theodorou1,
  2. Ganesh Rajasekar2,
  3. Nikia R. McFadden2,
  4. Erin G. Brown1,
  5. Miriam Nuño2,3
  1. 1Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, California, USA
  2. 2Department of Surgery, University of California Davis Medical Center, Sacramento, California, USA
  3. 3Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Sacramento, CA, USA
  1. Correspondence to Dr Christina M. Theodorou, Department of General Surgery, Division of Pediatric General, Thoracic, and Fetal Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA; ctheodorou{at}


Background Drowning 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.

Methods Children ≤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.

Results Among 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).

Conclusions Hospitalisations 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.

  • drowning
  • child
  • epidemiology

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  • CMT and GR are joint first authors.

  • Twitter @CTheodorouMD

  • Contributors Authors CMT, GR, NRM, EGB and MN conceived of and designed the study. Authors GR and MN performed the statistical analyses. Authors CMT and GR wrote the manuscript. Authors NRM, EGB and MN critically revised the manuscript.

  • Funding The project described was supported by the National Centre for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860 for authors CMT, NRM and EGB.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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