P3A285: California Child Drowning: A New Perspective

Background: Drowning has been the leading cause of unintentional injury-related death among children 1-4 years of age in the U.S. and California for at least three decades. The California Pool Safety Act of 1996 required a private residential single-family home pool to be equipped with at least 1 of 7 specified safety features. The 2017 updated law required that a pool be equipped with at least 2 of the 7 safety features. The purpose of this study was to 1) determine overall rates of fatal drownings for California children 0-17 years from 1999-2021 and 2) further analyze 1-4-year-old drowning incident rates by location and outcome.

Methods: Data were abstracted from the California Department of Public Health EpiCenter online publicly available database. This is a comprehensive source of injury data for California residents. In 1999, EpiCenter started using ICD-10 codes for fatalities. In 2016, EpiCenter was redesigned to include injury hospitalizations and emergency department visits, but intent was coded as undetermined for a large proportion of cases. Therefore, we included all drowning cases (unintentional, intentional, and undetermined intent) for this study starting from 1999 when ICD-10 codes were first used. We used ICD-10 codes W67 and W68 to identify pool drownings.

Results: Overall, annual rates of fatal drowning from 1999-2021 among California child residents 0-17 years have declined to a low of 0.8/100,000. Since 1999 there has been a steep decline in drowning deaths among children 1-4 years to 1.2/100,000 in 2017 followed by an uptick to 1.8/100,000 in 2021. Pools accounted for 62% of these drownings and showed a similar pattern. (Figure 1.) For every fatal drowning among 1-4-year-olds, there were 4 hospitalizations and 13 emergency department (ED) visits. (Figure 2.) Additionally, males had higher rates of fatality, hospitalization, and ED visits than females.

Conclusion: Since 1999, there has been a decline in fatal drowning incidents among children 0-17 years and 1-4-year-olds – the high-risk age group. This decline may be partially due to improved prehospital and hospital care. The anticipated decrease in fatal drowning rates after the implementation of the 2017 California Pool Safety Law has not been realized. The uptick in fatality rates among children 1-4 years at pools requires further information on the pool location. The EpiCenter 2016 redesign to include hospital and ED visits improves our understanding of the extent of drowning but is limited on the circumstances to inform prevention. The American Academy of Pediatrics (AAP)-California has achieved remarkable advocacy success with the Newman, Ch. 817, Stat. 2022: Childhood Drowning Data Collection Pilot Project. This moves us closer to the AAP recommendation that states establish systematic reporting on the circumstances of drowning in order to develop best practices, community interventions, and relevant public policies.