History and exam

Key diagnostic factors

common

presence of risk factors

Strong risk factors include young age, male sex, alcohol and drug use, swimming alone/diving, lack of awareness of water hazard risks, water exposure, and lack of swimming ability.

respiratory impairment

Drowning results from primary respiratory impairment from submersion/immersion in a liquid.[2]

evidence of submersion or immersion

A liquid/air interface at the entrance of the airway prevents the individual from breathing air.[2]

Other diagnostic factors

common

hypothermia

Hypothermia may be a sign of prolonged exposure to water or a long period of cardiac arrest.

signs of trauma

May suggest a cervical spine injury if any injuries over the shoulders.

Risk factors

strong

age (1-4 years)

Rates of fatal and nonfatal drowning are highest among children <4 years of age.[20][21]

male sex

Drowning is five times more common in adolescent and adult males than in females.[22][23]

alcohol or drug intake

Alcohol intoxication is commonly implicated in drowning incidents.[23][24][25] Its role in drowning primarily relates to alcohol's ability to impair judgment, orientation, reflexes, and motor activity. Similarly, any other substance use can impair judgment, alertness, and coordination, resulting in drowning incidents.

swimming alone/diving

High-risk behaviors such as swimming alone and diving, in addition to alcohol and drug use, have been associated with increased risk of drowning death, especially in males.[26]

lack of awareness of water hazard risks

Improper evaluation of high-risk swimming conditions contributes to an increased risk of drowning.

exposure to water

The ability to swim may lead to increased exposure to water or increased risk-taking in water.[27]

lack of swimming ability

There is some evidence demonstrating a causal relationship between the ability to swim and reduced risk of drowning death. In one study undertaken in rural Bangladesh, a structured swimming program significantly reduced fatal drowning in children.[28]

cardiac disease

Older adults are at higher risk for drowning death secondary to cardiac events in the water.[29] Additionally, channelopathies such as prolonged QT syndrome have been associated with an increased risk of drowning death, especially at open water events.[30]

seizure disorder

A seizure while in or around water may lead to drowning. Evidence suggests an increased risk of drowning for individuals with seizure disorders.[31][32][33]

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