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------=_NextPart_01C7EFDD.5CE08F60 Content-Location: file:///C:/6F15DE0C/drowningStat2000-2006.html_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C7EFDD.5CE08F60 Content-Location: file:///C:/6F15DE0C/drowningStat2000-2006.html_files/slide0024.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" CCOWS - Drowning, Near-Drowning, and Pediatric Cardiac Arrest
Unintentional Drownin= g to Florida Residents
Aged 0-4 Years, 2000-2006
•Steve Dearwater
•Jackson Memorial Hospital
•Miami-Dade County Injury Surveillance System=
I̵= 7;d like to review the incidence and some characteristics of drowning incidents to FL children aged 0-4 yrs. and, while doing so, discuss some of the problems = and pitfalls we have trying to report useful information about these injuries with the data sources currently available
------=_NextPart_01C7EFDD.5CE08F60 Content-Location: file:///C:/6F15DE0C/drowningStat2000-2006.html_files/slide0086.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" CCOWS - Drowning, Near-Drowning, and Pediatric Cardiac Arrest
•Drowning, 2000-2006:= Death Certificates
Unintentional Drowning to Florida Residents
Aged 0-4 Years, 2000-2006
•<= span style=3D'font-size:94%;color:white;mso-color-index:0'>Drowning & Near-Drowning Incidents, 2005: Death Certificates, Hospital Discharge Data= and ED Data
•<= span style=3D'font-size:94%;color:white;mso-color-index:0'>Examine Drowning Characteristics 2000-2006: Miami-Dade Co. Medical Examiner Data 
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2006 Florida Drowning Rate
 Why We Foc= us on Age 0-4
Why do= we need to focus on drowning to children aged 4 and younger?
These = data represent drowning cases to FL residents in 2006 expressed as rates for 7 different= age groups.
The dr= owning rate for this age group is at least 5 time higher than any other age group.
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Incidence and Epidemiology
Age 0-4 Drowning= 3;
=
•
•~500 Children Aged 0-4 years old Drown
•    Each Year in the US&#= 13;
•<= span style=3D'font-size:81%;color:white;mso-color-index:0;display:none'>
•Nationally, 2nd Lead= ing Cause of Injury-related Death for Children Aged 1-4 Years Old <= /span>
–
•In Florida, Leading = Cause of All Deaths for Children Aged 1-4 Years Old
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2006 Leading Causes of Death
 Florida Residents Aged 1-4
This s= lide shows all the causes of death for Florida children aged 1-4 yrs in 2006.
UD was= responsible for 1 of every 5 deaths and was nearly two time greater than the 2nd= leading cause, C.A.
In fac= t, the subset of drowning incidents that occurred in swimming pools alone would represe= nt the leading cause of death in this age group.
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Age 0-4 Drowning:
2002-2004 Geographic Distribution
•Highest Incidence
–Western states =
–Southern states
–Southwestern states<= /span>
–
•Lowest Incidence
–Northeast US<= /span>
This s= lide shows the states with the highest drowning rate for children age 0-4 for the years 2002-2004, which is the most recent national data that is available.
Nation= ally, the highest incidence occurred in western states like ID & AK, SW states = like OK, NM  & southern state= s of FL, TN & LA.  However, t= he 69 deaths avg. by FL annually is more than all these other states combined.<= /font>

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Florida Age 0-4 Drowning Incidence:
2000-2006
This s= hows the 7-year incidence of child drowning in FL between 2000-2006.
With t= he exception of an unusually high year in 2003, the incidence has been consistently between the mid-sixties and mid-seventies since 2001.
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Florida Age 0-4 Drowning Rate:
2000-2006 Trend
This i= s that same drowning incidence data between 2000-2006 only expressed as a rate to con= trol for the number of children aged 0-4 each year and we see a similar pattern over this period with the rate inching up slowly over the past 3 years
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2006 Florida Age 0-4 Drowning:
= Gender, Race & Ethnic Differences
•<= /span>Males
–<= /span>70% of Deaths from Drowning
–<= /span>Twice the Drowning Rate of Females
•
•<= /span>Whites
–<= /span>3/4 of Deaths from Drowning
–<= /span>22% higher rate than African Americans =
–
•<= /span> Hisp= anic Ethnicity
–<= /span>No Statewide Difference
In 200= 6, males were more likely to be drowning victims than females, with a rate that was twi= ce as high.
White = children in this age group had a drowning rate 22% higher than A-A children
And al= though there was no ethnic difference in the drowning rate statewide, some counties wi= th higher Hispanic pops saw lower drowning rates for Hispanic children compa= red to non-Hispanics
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x38MyIEsyINMx4EAADs= ------=_NextPart_01C7EFDD.5CE08F60 Content-Location: file:///C:/6F15DE0C/drowningStat2000-2006.html_files/slide0067.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" CCOWS - Drowning, Near-Drowning, and Pediatric Cardiac Arrest
Florida Age 0-4 Drowning, 2004-2006
County of Residence
Where = are these drowning incidents occurring?
This g= raph shows those FL counties that experienced at least 9 drowning incidents between 2004-2006.  Broward, MD and = Palm Beach had the highest number of drownings during these 3 years.
Howeve= r, when expressed as a rate, we see some of the counties with fewer numbers of ca= ses, like Brevard and Polk, actually at greater risk for one of their children becoming a drowning victim.


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•= ~6 Nonfatal Incident= s   for every Drowning t= o Children Aged 0-4
2005 Drowning & Near-Drowning
 Age 0-4 Fl= orida Residents
* 51 ED Cases with Discharge Status of Transfer to Other Hospital excluded
• 
<= span style=3D'mso-special-format:bullet;color:#FFCC66;position:absolute;left:-1= 1.69%'>•Similar Percentage o= f = Pool Incidents: = ;
–75% of Drowning =
–65-75% of Hospital&#= 13;
–60-70% of ED Visits&= #13;
–=
<= span style=3D'mso-special-format:bullet;color:#FFCC66;position:absolute;left:-1= 2.42%'>•~5 Nonfatal Pool = Incidents for every<= span style=3D'mso-spacerun:yes'>    = Pool Drowning to = Children Aged 0-4
Drowni= ng represents only a small part of this problem. Many more children experience near-drowning incidents.
2005 w= as the first year FL was able to measure injury in emergency depts., adding to our existing data of deaths and hospitalizations.
We see= that besides the 71 deaths, there were an additional 179 incidents where the victim was hospitalized and another 169 emergency dept visits that were treated and released.
Theref= ore, for every death, there were ~6 additional nonfatal drowning incidents.

If we = just look at the breakdown of swimming pool related cases, we know that 75% of the drownings were pool-related cases and that the nonfatal cases had a simil= ar proportion of pool-related cases. These are expressed as ranges because nonfatal data has a significant portion of their incidents classified as unspecified with regard to where the near-drowning occurred.
ItR= 17;s a safe estimate that there are ~5 nonfatal pool incidents for every pool related drowning
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•Nonfatal drowning incidents affected <= /span>every age in this age group but, like = drowning, were most frequent in children < 3 yrs.=
2005 Drowning & Near-Drowning
 Age 0-4 Fl= orida Residents
This s= lide is simply showing the distribution of fatal and nonfatal incidents for each year of= age in this 5-year age group.  A= nd it show that nonfatal cases affect every year of age but that, like drowning, occur more frequently in children < 3 years old and highest in 1 yr old children.
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file:///C:/6F15DE0C/drowningStat2000-2006.html_files/slide0048.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" CCOWS - Drowning, Near-Drowning, and Pediatric Cardiac Arrest
•14 counties with at least    9 incidents in 2005&= #13;
= •
•<= span style=3D'font-size:69%;color:white;mso-color-index:0'>Broward, Miami-Dade,= and Palm Beach Counties experienced= the greatest number = of drowning and near-drowning incidents t= o residents aged 0-4 <= /span>years in 2005.
The la= rger counties of Broward, MD and PB had the greatest numbers of combined fatal and nonf= atal incidence in 2005.
This g= raph shows only those counties that experienced at least 9 fatal or nonfatal inciden= ts during 2005.
It als= o shows that the nonfatal data is important for monitoring the risk for drowning becau= se counties like Lee and Collier experienced no deaths in 2005 and several others had only 1 death but many more nonfatal incidents.
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•14 counties with at least  9 incidents in 2005&= #13;
•
•= Marion and Osceola <= /span>Counties had the hig= hest rate of drowning and= near-drowning incide= nts to residents aged 0-= 4 years in 2005 <= /span>
•
•= Rates are based on a= single year and rela= tively = small number can be unstable
•
Like t= he drowning rates we saw previously, county rates for fatal and nonfatal drowning dur= ing 2005 were highest in some of the counties with fewer numbers of cases - Marion and Osceola Counties
I woul= d caution that these rates, and ones that we see later, are based on a single year and w= ith relatively small numbers and are therefore highly variable. We need to wa= tch them over several years to see these rates stabilize
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------=_NextPart_01C7EFDD.5CE08F60 Content-Location: file:///C:/6F15DE0C/drowningStat2000-2006.html_files/slide0084.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" CCOWS - Drowning, Near-Drowning, and Pediatric Cardiac Arrest
Identifying Swimming Pool Incidents
•ED Data became available in 2005 and doubled the number  of nonfatal cases= 3;
•
•HD and ED data still= undercount pool near= -drowning due to  improper E-Coding
= •
•= 2005 death certifica= tes provided narratives = to identify body of wat= er for cases coded as <= /span>unspecified
•
So wha= t can our data tell us about the magnitude and characteristics of drowning incidents that occurred in Swimming Pools?  Obtaining accurate surveillance data on swimming pool incidence is little more problematic that we would like.
This t= able shows how drowning was described between 2000-2006 from the underlying cause of dea= th code. We see pool drowning fluctuated between the 40’s to mid-fifti= es each year.
A chan= ge in the death certificate in 2005 provided several new variables of narrative text that provided some details on circumstances and location of injury. This allowed us to determine where many of the deaths that were coded as unspecified occurred.
We saw= was that pool drowning increased 9 cases in 2005 and 13 in the 2006 data.  We were also able to identify tw= ice as many bath tub incidents and were able to identify a specific type of water for most natural water incidents.
The ta= ke home point in this is that most of what we can report prior to 2005 for pool drownin= g is likely substantially undercounted and that monitoring of pool data is best done using data from 2005 forward, not only because of the limitations in= the death certificate but also because of the addition of ED data, which doub= led nonfatal cases over hospital data alone.=   And since nonfatal data doesn’t have the luxury of comparable text variables to reduced the number of cases coded as unspecified near drowning, they will remain undercounted to some degree.
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CCOWS - Drowning, Near-Drowning, and Pediatric Cardiac Arrest
2005-2006 Swimming Pool Drowning:
 Florida, A= ge 0-4
Seasonality
Using = the 2 good years of pool drowning data, we see these incidents peaked around Apr-May= and start declining after that
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2005 Swimming Pool Near-Drowning:
 Florida, A= ge 0-4
Seasonality
Our no= nfatal datasets only report injury in quarters but we see near-drowning demonstr= ated a similar seasonal pattern as drowning.
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•Counties with at lea= st 5 pool drowning incide= nts between 2004-2006= 3;
•
•Marion, Osceola and = Brevard Counties had= a swimming pool drowni= ng rate for the years 2= 004-2006 that was more t= han twice the state rate= .
This s= lide shows the swimming pool drowning rates for those counties that experienced at least= 5 deaths for the period of 2004-2006.
The po= ol rate for Marion, Osceola and Brevard were more than 2 times the state rate but aga= in are based on low numbers and will be monitored over time
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•Counties with at least  7 pool drowning or <= /span>near-drowning incidents in 2005= 3;
= •
•Sarasota, Collier an= d Marion Counties had = the highest rate of = drowning and near-drowning swimming pool incidents in 20= 05
And th= e rate for all severity cases were highest in Sarasota and Collier
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•Counties with at least  7 pool drowning or <= /span>= near-drowning = incidents in 2005= 3;
<= span style=3D'font-size:66%;color:white;mso-color-index:0;visibility:hidden'>•
•= Miami-Dade, Palm Beach and Broward Counties experienced= the greatest number = of drowning and near= -drowning swimming = pool incidents to = residents aged 0-4 <= /span>years in 2005.
When w= e add in the nonfatal pool incidents using the 2005 data, as expected Broward, PB and = MD experienced the most cases.
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•2003-05 Rate vs,
•2004-06 Rate
•(minimum 9 deaths: 04-06)
• = ;
•Increase: Pinellas, = Brevard, Polk
•   
•Slight Increase: Hillsborough,   Palm Beach
•
•Decrease: State, Orange, Broward, Miami-Dade
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I= ’d like to review the incidence and some characteristics of drowning <= span style=3D'font-size:117%'>incidents to FL children aged 0-4 yrs. and, while= doing so, discuss some of the problems and pitfalls we have trying to report useful information about these injuries with the data sources currently available
W= hy do we need to focus on drowning to children aged 4 and younger? These data represent drowning cases to FL residents in 2006 expressed as rates for 7 different age groups. &#= 13;The drowning rate for this age group is at least = 5 time higher than any other age group.
T= his slide shows all the causes of death for Florida children aged 1-4 yrs in 2006. UD was responsible for 1 of every 5 deaths and was nearly two time greater than the 2nd lea= ding cause, C.A.  In fact, the subset of drowning incidents that oc= curred in swimming pools alone would repres= ent the leading cause of death in this age group.
T= his slide shows the states with the highest drowning rate for children age 0-4 for the years 2002-2004, which i= s the most recent national data that is available. Nationally, the high= est incidence occurred in western states like ID & AK, SW states like OK, NM  & southern states of FL, TN &= amp; LA.  However, the 69 deaths avg. by FL annually is more than all these other states combined.
T= his shows the 7-year incidence of child drowning in FL between 2000-2006. With the exception of an unusually high year in 2003, the incidence has been consistently between the mid-sixties and mid-seventies since 2001.
T= his is that same drowning incidence data between 2000-2006 only expressed as a rate to control for the number of children aged 0-4 each year and we s= ee a similar pattern over this period with the rate inching up slowly over the past 3 years 
In= 2006, males were more likely to be drowning victims than females, with a rate that was twice as high. = ;White children in this age group had a drowning r= ate 22% higher than A-A children And although there was no ethnic difference in the drowning rate statewide, some counti= es with higher Hispanic pops saw lower drowning rates for Hispanic children compared to non-Hispanics
Where are these drowning incidents occurring?
This graph shows those FL counties that experienced at least 9 drowning inci= dents between 2004-2006.  Broward, = MD and Palm Beach had the highest number of drownings during these 3 years.  However, when expressed = as a rate, we see some of the counties wi= th fewer numbers of cases, like Brevard and Polk, actually at greater risk for one of their children becoming a drowning victim.
D= rowning represents only a small part of this problem. Many more children experience near-drowning incidents. = ;2005 was the first year FL was able to measure in= jury in emergency depts., adding to our existing data of deaths and hospitalizations. We see that besides the 71 deaths, there were an additional 179 incidents where the v= ictim was hospitalized and another 169 eme= rgency dept visits that were treated and released. Therefore, for every death, there were ~6 additional nonfatal drowning incidents.
If we just look at the breakdown of swimmin= g pool related cases, we know that 75% of t= he drownings were pool-related cases and that the nonfatal cases had a similar proportion of pool-related cases. These are expressed as ranges because nonfatal da= ta has a significant portion of their incid= ents classified as unspecified with regar= d to where the near-drowning occurred.  It’s a safe estima= te that there are ~5 nonfatal pool incidents for every pool related drowning
T= his slide is simply showing the distribution of fatal and nonfatal incidents for each year of age in this 5-year age group.  And it show that nonfatal cases affect every year of age but = that, like drowning, occur more frequently= in children < 3 years old and highest in 1 yr old children.
T= he larger counties of Broward, MD and PB had the greatest numbers of combined fatal and nonfatal incidence in 2005. This graph shows only those counties that experie= nced at least 9 fatal or nonfatal inciden= ts during 2005. It also shows that= the nonfatal data is important for monitoring the risk for drowning because counties like Lee and Collier experienced = no deaths in 2005 and several others had only 1 d= eath but many more nonfatal incidents.
L= ike the drowning rates we saw previously, county rates for fatal and nonfatal drowning during 2005 were highest in som= e of the counties with fewer numbers of c= ases - Marion and Osceola Counties I w= ould caution that these rates, and ones that we see later, are based on a single year and with relatively small numbers and are therefore highly var= iable. We need to watch them over several years to see these rates stabilize
S= o what can our data tell us about the magnitude and characteristics of drowning incidents that occurred in Swimming Pools?  Obtaining accurate surveillance data on swimming pool incid= ence is little more problematic that we w= ould like.
T= his table shows how drowning was described between 2000-2006 from the underlying cause of death code. We see p= ool drowning fluctuated between the 40&#= 8217;s to mid-fifties each year.
A= change in the death certificate in 2005 provided several new variables of narrative text that provided some de= tails on circumstances and location of inj= ury. This allowed us to determine where m= any of the deaths that were coded as unspecified occurred.
W= e saw was that pool drowning increased 9 cases in 2005 and 13 in the 2006 data.&n= bsp; We were also able to identify twice as many bath tub incidents and were able to identify a specific ty= pe of water for most natural water inciden= ts.
T= he take home point in this is that most of what we can report prior to 2005 for pool drowning is likely substantially undercounted and that monitoring of = pool data is best done using data from 2005 forward, not only because of the limitations in the death certificate but also because of the addition of ED data, which doubled nonfatal cases over hospital= data alone.  And since nonfatal da= ta doesn’t have the luxury of comparable text variables to reduced the number of cases coded as unspecified near drowning, they will remain undercounted to some degree.
U= sing the 2 good years of pool drowning data, we see these incidents peaked around Apr-May and start declining after that
O= ur nonfatal datasets only report injury in quarters but we see near-drowning demonstrated a similar seasonal pattern = as drowning.
T= his slide shows the swimming pool drowning rates for those counties that experienced at least 5 deaths for t= he period of 2004-2006. The pool rate for Marion, Osceola and Brevard wer= e more than 2 times the state rate but agai= n are based on low numbers and will be mon= itored over time