Drowning Differential Diagnoses

  • Author: Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Aug 23, 2011
 
 

Diagnostic Considerations

Secondary causes of drowning should always be considered. Consider child abuse in young children who are the victims of submersion injury in bathtubs, buckets, or other shallow water receptacles.

Other problems to consider include the following:

  • Head trauma
  • Cervical spine injury
  • Arrhythmia
  • Seizure
  • Baric injury, including air embolism
  • Hypoglycemia
  • Suicide
  • Homicide
  • Hazing
  • Gang initiation
  • Marine envenomation, including Cnidarian, cone shell, stonefish

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM  Associate Professor, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Michael J Verive, MD  Medical Director, Pediatric Intensive Care, Department of Pediatrics, St Mary's Hospital for Women and Children

Michael J Verive, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, Pediatric Sedation, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

G Patricia Cantwell, MD, FCCM  Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

William H Shoff, MD, DTM&H  Director, PENN Travel Medicine; Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Glaxo Smith Kline None None; Glaxo Smith Kline Honoraria Speaking and teaching

Specialty Editor Board

Robert L Norris, MD  Professor, Department of Surgery, Chief, Division of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Barry J Evans, MD  Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors James Martin, MD, and Michael Fiore, MD, to the development and writing of the source articles.

References
  1. Health, United States 1996-97 and Injury Chartbook. DHHS Publication No (PHS) 96-1232. US Department of Health and Human Services. Hyattsville, Md: National Center for Health Statistics;. 1997.

  2. Papa L, Hoelle R, Idris A. Systematic review of definitions for drowning incidents. Resuscitation. Jun 2005;65(3):255-64. [Medline].

  3. van Beeck EF, Branche CM, Szpilman D, Modell JH, Bierens JJ. A new definition of drowning: towards documentation and prevention of a global public health problem. Bull World Health Organ. Nov 2005;83(11):853-6. [Medline]. [Full Text].

  4. Orlowski JP. Drowning, near-drowning, and ice-water submersions. Pediatr Clin North Am. Feb 1987;34(1):75-92. [Medline].

  5. Suominen P, Baillie C, Korpela R, Rautanen S, Ranta S, Olkkola KT. Impact of age, submersion time and water temperature on outcome in near-drowning. Resuscitation. Mar 2002;52(3):247-54. [Medline].

  6. Garzoni C, Garbino J. Long-term risk of atypical fungal infection after near-drowning episodes. Pediatrics. Feb 2007;119(2):417; author reply 417-8. [Medline].

  7. Lunetta P, Modell JH, Sajantila A. What is the incidence and significance of "dry-lungs" in bodies found in water?. Am J Forensic Med Pathol. Dec 2004;25(4):291-301. [Medline].

  8. Citro R, Previtali M, Bossone E. Tako-tsubo cardiomyopathy and drowning syndrome: is there a link?. Chest. Aug 2008;134(2):469. [Medline].

  9. Choi G, Kopplin LJ, Tester DJ, Will ML, Haglund CM, Ackerman MJ. Spectrum and frequency of cardiac channel defects in swimming-triggered arrhythmia syndromes. Circulation. Oct 12 2004;110(15):2119-24. [Medline].

  10. Cortez KJ, Roilides E, Quiroz-Telles F, Meletiadis J, Antachopoulos C, Knudsen T, et al. Infections caused by Scedosporium spp. Clin Microbiol Rev. Jan 2008;21(1):157-97. [Medline]. [Full Text].

  11. Leechawengwongs M, Milindankura S, Liengudom A, Chanakul K, Viranuvatti K, Clongsusuek P. Multiple Scedosporium apiospermum brain abscesses after near-drowning successfully treated with surgery and long-term voriconazole: a case report. Mycoses. Nov 2007;50(6):512-6. [Medline].

  12. Mesfin FB, Tobin E, Adamo MA, Dirisio D. Fungal vertebral osteomyelitis due to Scedosporium apiospermum after near-drowning. J Neurosurg Spine. Jul 2008;9(1):58-61. [Medline].

  13. Kantarcioglu AS, Guarro J, de Hoog GS. Central nervous system infections by members of the Pseudallescheria boydii species complex in healthy and immunocompromised hosts: epidemiology, clinical characteristics and outcome. Mycoses. Jul 2008;51(4):275-90. [Medline].

  14. Tintelnot K, Wagner N, Seibold M, de Hoog GS, Horré R. Re-identification of clinical isolates of the Pseudallescheria boydii-complex involved in near-drowning. Mycoses. Sep 2008;51 Suppl 3:11-6. [Medline].

  15. Kakizaki E, Kozawa S, Sakai M, Yukawa N. Bioluminescent bacteria have potential as a marker of drowning in seawater: two immersed cadavers retrieved near estuaries. Leg Med (Tokyo). Mar 2009;11(2):91-6. [Medline].

  16. Suto M, Kato N, Abe S, Nakamura M, Tsuchiya R, Hiraiwa K. PCR detection of bacterial genes provides evidence of death by drowning. Leg Med (Tokyo). Apr 2009;11 Suppl 1:S354-6. [Medline].

  17. U.S. Consumer Product Safety Commission. Safety Barrier Guidelines for Home Pools. Cited Mar 2007. Available at http://www.cpsc.gov/cpscpub/pubs/pool.pdf.

  18. Brenner RA, Trumble AC, Smith GS, Kessler EP, Overpeck MD. Where children drown, United States, 1995. Pediatrics. Jul 2001;108(1):85-9. [Medline].

  19. Byard RW. Rainwater tank drowning. J Forensic Leg Med. Nov 2008;15(8):533-4. [Medline].

  20. Rahman A, Shafinaz S, Linnan M, Rahman F. Community perception of childhood drowning and its prevention measures in rural Bangladesh: a qualitative study. Aust J Rural Health. Jun 2008;16(3):176-80. [Medline].

  21. Värnik A, Kõlves K, van der Feltz-Cornelis CM, Marusic A, Oskarsson H, Palmer A, et al. Suicide methods in Europe: a gender-specific analysis of countries participating in the "European Alliance Against Depression". J Epidemiol Community Health. Jun 2008;62(6):545-51. [Medline]. [Full Text].

  22. Jonkman SN, Maaskant B, Boyd E, Levitan ML. Loss of life caused by the flooding of New Orleans after Hurricane Katrina: analysis of the relationship between flood characteristics and mortality. Risk Anal. May 2009;29(5):676-98. [Medline].

  23. Centers for Disease Control and Prevention. Unintentional Drowning: Fact Sheet. Accessed August 4, 2011. Available at http://www.cdc.gov/HomeandRecreationalSafety/Water-Safety/waterinjuries-factsheet.html.

  24. Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. Wisqars Details of Leading Causes of Death. National Center for Health Statistics (NCHS), National Vital Statistics System. Accessed June 2009. Available at http://webappa.cdc.gov/sasweb/ncipc/leadcaus10.html.

  25. Safe Kids USA. Drowning Prevention. Accessed 2009. Available at http://www.safekids.org/our-work/research/fact-sheets/drowning-prevention-fact-sheet.html.

  26. Culp WC Jr, Brewster BC, Wernicki P. Drowning: lifeguard rescue and resuscitation. Anesthesiology. Jan 2010;112(1):245; author reply 246. [Medline].

  27. Kanchan T, Menezes RG, Monteiro FN. Fatal unintentional injuries among young children--a hospital based retrospective analysis. J Forensic Leg Med. Aug 2009;16(6):307-11. [Medline].

  28. Papadakis M, Sharma S, Cox S, et al. The magnitude of sudden cardiac death in the young: A death certificate-based review in England and Wales. Europace. 2009;11:353-58.

  29. National Water Safety Forum, UK. Water-related fatalities, 2005. 2005. [Full Text].

  30. Dean R, Mulligan J. Management of water incidents: drowning and hypothermia. Nurs Stand. Oct 21-27 2009;24(7):35-9. [Medline].

  31. Royal Society for the Prevention of Accidents. Accidental drowning 2005. 2005;. [Full Text].

  32. Hyder AA, Sugerman DE, Puvanachandra P, Razzak J, El-Sayed H, Isaza A, et al. Global childhood unintentional injury surveillance in four cities in developing countries: a pilot study. Bull World Health Organ. May 2009;87(5):345-52. [Medline]. [Full Text].

  33. Hong J, Lee B, Ha EH, Park H. Parental socioeconomic status and unintentional injury deaths in early childhood: consideration of injury mechanisms, age at death, and gender. Accid Anal Prev. Jan 2010;42(1):313-9. [Medline].

  34. Morgan D, Ozanne-Smith J, Triggs T. Direct observation measurement of drowning risk exposure for surf beach bathers. J Sci Med Sport. Jul 2009;12(4):457-62. [Medline].

  35. Morgan D, Ozanne-Smith J, Triggs T. Self-reported water and drowning risk exposure at surf beaches. Aust N Z J Public Health. Apr 2009;33(2):180-8. [Medline].

  36. Morgan D, Ozanne-Smith J, Triggs T. Descriptive epidemiology of drowning deaths in a surf beach swimmer and surfer population. Inj Prev. Feb 2008;14(1):62-5. [Medline].

  37. Ihama Y, Miyazaki T, Ferke C, et al. Scuba-diving related deaths in Okinawa, Japan, from 1982-2007. Legal Medicine. 2007;10:119-24.

  38. Denoble PJ, Caruso JL, Dear Gde L, Pieper CF, Vann RD. Common causes of open-circuit recreational diving fatalities. Undersea Hyperb Med. Nov-Dec 2008;35(6):393-406. [Medline].

  39. Buzzacort P, Rosenberg M, Pikora T. Western Australian recreational scuba diving fatalities. Austral N Z Public Health. 1992-2005;2009;33:212-14.

  40. Laursen LH, Hansen HL, Jensen OC. Fatal occupational accidents in Danish fishing vessels 1989-2005. Int J Inj Contr Saf Promot. Jun 2008;15(2):109-17. [Medline].

  41. Brooks CJ, MacDonald CV, Donati L, Taber MJ. Civilian helicopter accidents into water: analysis of 46 cases, 1979-2006. Aviat Space Environ Med. Oct 2008;79(10):935-40. [Medline].

  42. Wilks J. Injuries and injury prevention. In: Keystone J, Kozarsky P, et al. Travel Medicine. London: Mosby; 2004:453-59.

  43. Guse CE, Cortés LM, Hargarten SW, Hennes HM. Fatal injuries of US citizens abroad. J Travel Med. Sep-Oct 2007;14(5):279-87. [Medline].

  44. Leggat PA, Wilks J. Overseas visitor deaths in Australia, 2001 to 2003. J Travel Med. Jul-Aug 2009;16(4):243-7. [Medline].

  45. Berger LR, Wallace LJ, Bill NM. Injuries and injury prevention among indigenous children and young people. Pediatr Clin North Am. Dec 2009;56(6):1519-37. [Medline].

  46. Gramsbergen A, Hadders-Algra M. Development of postural control, a basic aspect of neuro-ontogeny. Neurosci Biobehav Rev. Jul 1998;22(4):463-4. [Medline].

  47. Wintemute GJ, Wright MA. Swimming pool owners' opinions of strategies for prevention of drowning. Pediatrics. Jan 1990;85(1):63-9. [Medline].

  48. Herman-Giddens ME, Smith JB, Mittal M, Carlson M, Butts JD. Newborns killed or left to die by a parent: a population-based study. JAMA. Mar 19 2003;289(11):1425-9. [Medline].

  49. Fugiwara T, Barber C, Schaechter J, Hemenway D. Characteristics of infant homicides: Findings from a US multisite reporting system. Pediatr. 2009;124:e210-17..

  50. Dias MS, Smith K, DeGuehery K, Mazur P, Li V, Shaffer ML. Preventing abusive head trauma among infants and young children: a hospital-based, parent education program. Pediatrics. Apr 2005;115(4):e470-7. [Medline].

  51. Giesbrecht GG, Pretorius T. Survey of public knowledge and responses to educational slogans regarding cold-water immersion. Wilderness Environ Med. Winter 2008;19(4):261-6. [Medline].

  52. Layon AJ, Modell JH. Drowning: Update 2009. Anesthesiology. Jun 2009;110(6):1390-401. [Medline].

  53. [Best Evidence] Bell GS, Gaitatzis A, Bell CL, Johnson AL, Sander JW. Drowning in people with epilepsy: how great is the risk?. Neurology. Aug 19 2008;71(8):578-82. [Medline].

  54. Kanchan T, Menon A, Menezes RG. Methods of choice in completed suicides: gender differences and review of literature. J Forensic Sci. Jul 2009;54(4):938-42. [Medline].

  55. Salib E. Trends in suicide by drowning in the elderly in England and Wales 1979-2001. Int J Geriatr Psychiatry. Feb 2005;20(2):175-81. [Medline].

  56. Purandare N, Voshaar RC, Rodway C, Bickley H, Burns A, Kapur N. Suicide in dementia: 9-year national clinical survey in England and Wales. Br J Psychiatry. Feb 2009;194(2):175-80. [Medline].

  57. Warner DS, Bierens JJ, Beerman SB, Katz LM. Drowning: a cry for help. Anesthesiology. Jun 2009;110(6):1211-3. [Medline].

  58. Varon J, Acosta P. Therapeutic hypothermia: past, present, and future. Chest. May 2008;133(5):1267-74. [Medline].

  59. Kyriacou DN, Arcinue EL, Peek C, Kraus JF. Effect of immediate resuscitation on children with submersion injury. Pediatrics. Aug 1994;94(2 Pt 1):137-42. [Medline].

  60. Quan L, Kinder D. Pediatric submersions: Pre-hospital predictors of outcome. Pediatr. 1992;90:909-13.

  61. Youn CS, Choi SP, Yim HW, Park KN. Out-of-hospital cardiac arrest due to drowning: An Utstein Style report of 10 years of experience from St. Mary's Hospital. Resuscitation. Jul 2009;80(7):778-83. [Medline].

  62. Eich C, Russo SR, Heuer JF, et al. Characteristics of out-of-hospital pediatric emergencies attended by ambulanc and helicopter-based emergency physicians. Resuscitation. 2009;80:888-92.

  63. Sayre MR, Berg RA, Cave DM, Page RL, Potts J, White RD. Hands-only (compression-only) cardiopulmonary resuscitation: a call to action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee. Circulation. Apr 22 2008;117(16):2162-7. [Medline].

  64. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. Feb 21 2002;346(8):549-56. [Medline].

  65. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. Feb 21 2002;346(8):557-63. [Medline].

  66. Cubattoli L, Franchi F, Coratti G. Surfactant therapy for acute respiratory failure after drowning: two children victim of cardiac arrest. Resuscitation. Sep 2009;80(9):1088-9. [Medline].

  67. Onarheim H, Vik V. Porcine surfactant (Curosurf) for acute respiratory failure after near-drowning in 12 year old. Acta Anaesthesiol Scand. Jul 2004;48(6):778-81. [Medline].

  68. Mizobuchi M, Nakamura S, Muranishi H, Utsunomiya M, Funatsu A, Kobayashi T, et al. Hypothermia with extracorporeal membrane oxygenation for sudden cardiac death and submersion. Am J Emerg Med. Jan 2010;28(1):115.e1-4. [Medline].

  69. Kawati R, Covaciu L, Rubertsson S. Hypothermia after drowning in paediatric patients. Resuscitation. Nov 2009;80(11):1325-6. [Medline].

  70. Conn AW, Montes JE, Barker GA, Edmonds JF. Cerebral salvage in near-drowning following neurological classification by triage. Can Anaesth Soc J. May 1980;27(3):201-10. [Medline].

  71. Modell JH, Graves SA, Kuck EJ. Near-drowning: correlation of level of consciousness and survival. Can Anaesth Soc J. May 1980;27(3):211-5. [Medline].

  72. Ballesteros MA, Gutiérrez-Cuadra M, Muñoz P, Miñambres E. Prognostic factors and outcome after drowning in an adult population. Acta Anaesthesiol Scand. Aug 2009;53(7):935-40. [Medline].

  73. Modell JH. Legal Aspects and Litigation in Aquatic Lifesaving. In: Bierens J. Handbook on Drowning. 1. Heidelberg, Germany: Springer-Verlag; 2006:645-47.

  74. Wagner C. Pediatric submersion injuries. Air Med J. May-Jun 2009;28(3):116-9. [Medline].

  75. Brenner RA, Taneja GS, Haynie DL, et al. Association between swimming lessons and drowning in childhood: a case-controlled study. Arch Pediatr Adolesc Med. 2009;163:203-10.

  76. Carr WD. Formal swimming lessons must be defined. Arch Pediatr Adolesc Med. 2009;163:962.

  77. Branche CM, Stewart. Lifeguard effectiveness: A report of the working group. Atlanta: CDC National Center for Injury Prevention and Control. 2001.

  78. [Guideline] Prevention of drowning in infants, children, and adolescents. Pediatrics. Aug 2003;112(2):437-9. [Medline].

  79. Samuelson H, Nekludov M, Levander M. Neuropsychological outcome following near-drowning in ice water: two adult case studies. J Int Neuropsychol Soc. Jul 2008;14(4):660-6. [Medline].

Previous
Next
 
Mechanism of hypoxia in submersion injury.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.