Are paediatric submersion incidents preventable?
© BioMed Central Ltd 2001
Published: 1 March 1997
Because drowning is one of the leading causes of accidental death in children in civilized countries, we have studied the epidemiology and the preventability of severe submersion incidents in Finland.
A 10-year retrospective study of all the victims of severe submersion incident under 16 years of age who either required admission to the paediatric intensive care unit (PICU) or died in the Province of Uusimaa.
Of the 62 submersion victims 16 were female and 46 were male. Their ages ranged from 0 to 15 years and the median was 3.7 years. Fifteen patients were declared dead at scene without CPR. Five of the 24 patients in whom CPR was initiated had intact survival. Altogether 28 survivors had good neurological outcome and two had severe disability. Thirty-one patients died during the first 24 h and one died later. The annual rate of drownings per 100,000 persons under 16 years of age was 1.3. Seventy-seven per cent of the submersion incidents took place when children were left without adult supervision for a moment or children were playing themselves close to a waterway or in water. Seventy-one per cent of all submersion incidents occurred in freshwater bodies, 21% in swimming pools or baths and 8% in other places. The cause of submersion incident was a fall into water in 31, swimming or bathing in 15, a fall through ice in six, a homicide committed by child's own mother in five, negligence in three and miscellaneous in two cases.
Our results show that many of these submersion incidents could have been prevented by not leaving infants or toddlers without adult supervision even for a brief period in water or close to bodies of water. Earlier recognition of mother's need for psychiatric care and keeping children away from thin ice could have also prevented few incidents.
The probability of intact survival of nearly drowned children receiving CPR was not better than 21%. Because most of the submersion incidents appear to be preventable, investment in prevention programs would probably be the best and cheapest way to reduce mortality in paediatric submersion incidents.