Child Drowning Data Collection Tool

Phyllis Agran, MD, MPH
Van Greco
Diane Winn
Jaya Bhalla, BS
Nakia Best
Romeo Ignacio
Chaksu Soni
Soheil Saadat
Shahram Lotfipour

Drowning is the leading cause of unintentional injury death among U.S. and California 1-4-year-old children. The California EpiCenter Injury database provides information on rates of childhood drowning over time by victim demographics and location. However, addressing limitations to adequately inform prevention requires improved documentation of key variables for specific ICD-10 CM coding. Our goal is to improve data documented in medical records by creating a data collection tool that can be used in the hospital setting. Specific objectives were to 1) determine key elements for hospital-based record documentation and create a data collection tool; 2) review a sample of cases to indicate documentation gaps; and 3) create a simple guide for data collection and local surveillance.

We reviewed child drowning surveillance and data collection tools used at the national, state, and local levels, and produced a reference table and a “Flowchart: Outcomes and Sources of Data for Drowning Incidents” indicating portals for hospital record data entry. A team of healthcare experts participated in the development of the data collection tool. We then conducted a retrospective review using a convenience sample of 12 hospital records to identify data element gaps. We then developed the “Child Drowning Surveillance Guide.”

Portals of data entry for drowning cases were identified. The retrospective chart review of participant facilities revealed the following. General demographic information was well documented except for gaps in race (67%) and ethnicity (42%). Incident narratives included the location of the pool (documented in 92% of cases), child location prior to the event (83%), pool access (75%), and supervisor location (100%). Shortcomings included safety device (25%) and pool fence (33%) descriptions. All cases had a Social Worker consult.

Gaps identified in the state database resulting in “unspecified” and “unknown” codes that provide no further context to the drowning incident, such as location, can be addressed by improved hospital discharge data ICD-10 CM coding. However, ICD-10 code limitations call for more comprehensive surveillance systems. Our surveillance guide can be used for hospital documentation/surveillance, physician, nurse, and social worker training; child death team case review; and, social worker and home visitation professionals charged with assisting with a family safety plan to prevent drowning incident recurrence. The California Legislature found a solution to the statewide drowning data collection gap through the implementation of SB 855 (Newman, Ch. 817, Stat. 2022: Childhood Drowning Data Collection Pilot Program). This bill requires the State Department of Public Health to establish and administer the Childhood Drowning Data Collection Pilot Program for fatal and nonfatal incidents. Our Child Drowning Surveillance Guide can contribute to the establishment of electronic tools used for the state data collection system that will further inform prevention. Child Drowning Surveillance (UCI Institutional Review Board #1940, #1953)

1. Statewide Vital Statistics and Hospital Discharge Data are limited in contextual information regarding child drowning incidents.
2. ICD-10 CM coding gaps hamper hospital-based surveillance of child drowning incidents.
3. Enhanced medical record documentation of variables addresses these coding gaps.

Drowning Among 1–4-Year-Old Children in California, 2017-2021

Phyllis Agran, MD
Diane Winn, RN, MPH
Soheil Saadat, MD, PhD, MPH
Jaya Bhalla, BS
Van Nguyen Greco, MD
Nakia C. Best, RN, PhD
Shahram Lotfipour, MD, MPH

Drowning, the leading cause of unintentional injury death among California children less than 5 years averaged 49 annual fatalities for the years 2010-2021. The California Pool Safety Act aims to reduce fatalities by requiring safety measures around residential pools. This study was designed to analyze annual fatality rates and drowning incidents in California among 1-4-year-old children from 2017 to 2021.

Data for this study were obtained from the EpiCenter California Injury Data Online website. This is a comprehensive source of injury data limited to California residents. EpiCenter data includes fatalities, injury hospitalizations, and emergency department (ED) visits. Drowning fatalities were identified from the California Department of Public Health using ICD-10 cause-of-death codes appearing in the underlying cause-of-death field as follows: W65–W74, X71, X92, Y21, W65–W74, X71, X92, and Y21. Fatality rates were calculated from the California Department of Finance’s Report P-3: Complete State and County Projections Dataset (Baseline 2019 Population Projections; Vintage 2020 Release).

Over the five-year study period, 4,166 drowning incidents were identified; 234 were fatalities, 846 were hospitalizations, and 3,086 were ED visits. The observed difference in fatality rates from 2017 to 2021 failed to achieve statistical significance (p= 0.875). Location-based analysis of the 234 fatal drowning incidents revealed that pools were the most common injury site, accounting for 65% of the cases. The case fatality ratio for the 1-year-old age group stood at 7.86% (6.32% to 9.64%), which was higher than other age groups (p<0.001).

Drowning remains the leading cause of unintentional injury-related death among California children 1-4 years of age, as the annual rate of fatality over the five-year study period did not decline. While the EpiCenter California Injury Data Online website is excellent for analyzing annual rates of drowning incidents among California residents over time, it is limited in providing insight into modifiable risk factors and event circumstances that can further inform prevention. The development of robust integrated fatal and nonfatal local, state, and national systematic data collection systems can aid in moving the needle in decreasing pool fatalities among young children.

University of California Irvine IRB #1735

1. Drowning fatality rates among 1-4 year-old California children has not declined in the last 5 years, despite enactment of the updated 2017 Pool Safety Law.
2. The state database based on vital statistics and hospital discharge data is limited in addressing event circumstances.
3. Integrated fatal and nonfatal systematic data collection will contribute to improved prevention strategies.