Objectives This study is an analysis of the contribution of pre-existing medical conditions to unintentional fatal child (0–14 years) drowning and a of critique prevention stratagems, with an exploration of issues of equity in recreation.
Design This study is a total population, cross-sectional audit of all demographic, forensic and on-site situational details surrounding unintentional fatal drowning of children 0–14 years in Australia for the period of 1 July 2002 to 30 June 2012. Data were sourced from the National (Australia) Coronial Information System. Age-specific disease patterns in the general population were obtained from the Australian Institute of Health and Welfare.
Results Four hundred and sixty-eight children drowned during the study period. Fifty-three (11.3%) had a pre-existing medical condition, of whom 19 suffered from epilepsy, 13 from autism and 5 with non-specific intellectual disabilities. Epilepsy is a risk factor in childhood drowning deaths, with a prevalence of 4.1% of drowning fatalities, compared with 0.7%–1.7% among the general 0–14 years population (relative risk: 2.4–5.8). Epilepsy was deemed to be contributory in 16 of 19 cases (84.2% of epilepsy cases) with a median age of 8 years. Asthma and intellectual disabilities were under-represented in the drowning cohort.
Conclusion Except for epilepsy, this research has indicated that the risks of drowning while undertaking aquatic activities are not increased in children with pre-existing medical conditions. Children with pre-existing medical conditions can enjoy aquatic activities when appropriately supervised.
- injury prevention
- water safety
- cardio-pulmonary resuscitation
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Contributors RCF and JHP conceived the study. AEP sourced the data. JHP and RCF reviewed the medical details of each case. JHP and RCF formulated an interpretive judgement concerning whether the pre-existing medical condition was a direct cause, compromised a fatal drowning or was incidental. RCF conducted the analysis and wrote the manuscript. JHP assisted in the analysis and reviewed the manuscript. AEP reviewed the manuscript.
Disclaimer The lead author, RCF, affirms that the manuscript is an honest, accurate and transparent account of the study being reported, that no important aspects of the study have been omitted and that any discrepancies from the study as planned (and if relevant, registered) have been explained.
Competing interests None declared.
Patient consent Victims are deceased and data is stored by the data custodians, the Australian National Coronial Information System (NCIS). Access to researchers is governed under strict ethical protocols.
Ethics approval Department of Justice Human Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement With respect to the data set underlying this research, these data are available on request. However, as the data have been accessed via a third party (coronial data), ethical approval and permission from the data custodians, the Australian National Coronial Information System (NCIS) is required before the authors are able to provide their data set to the person inquiring. There are strict ethical restrictions around the use of these data, and it can therefore not be sent to a public repository. Once ethical approval and permission from the NCIS as data custodians has been achieved, researchers can contact firstname.lastname@example.org to gain access to the data.
Correction notice This paper has been amended since it was published Online First. Owing to a scripting error, some of the publisher names in the references were replaced with ’BMJ Publishing Group'. This only affected the full text version, not the PDF. We have since corrected these errors and the correct publishers have been inserted into the references.
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