Age group-related characteristics of pediatric drowning patients treated at an emergency medical center in northern Yeongseo, Gangwon Province

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Pediatr Emerg Med J. 2026;13(2):51-57

Publication date (electronic) : 2026 February 3

doi : https://doi.org/10.22470/pemj.2025.01487

Hyunseok Cho¹, Jin-Sung Park^,2, Yonghee Lee², Juyeon Jeon²

¹Department of Emergency Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea

²Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Republic of Korea

Corresponding author: Jin-Sung Park, Department of Pediatrics, Kangwon National University School of Medicine, 1 Gangwondaehak-gil, Chuncheon 24341, Republic of Korea Tel: +82-33-258-2000; E-mail: mokent@naver.com

Received 2025 October 18; Revised 2026 January 28; Accepted 2026 January 28.

Abstract

Introduction

Drowning is a submersion or immersion in a liquid that impairs breathing and is a serious yet often overlooked public health threat, causing approximately 372,000 deaths worldwide each year (1). According to the Global Status Report on Drowning Prevention 2024 (2), South Korea recorded 1.0 drowning deaths per 100,000 people in 2021, a sharp decline from 6.0 per 100,000 in 2000. Although drowning accounts for only 0.6% of all pediatric injury-related emergency department (ED) visits each year (3), it is a leading cause of death among children and adolescents (4). According to a survey performed by the Korean Ministry of Health and Welfare, the number of drowning deaths per 100,000 people is 2.1, 2.6, 1.6, and 1.4 for children or adolescents aged 1-4 years, 5-9 years, 10-14 years, and 15-19 years, respectively. In addition, relevant literature underscores the risk of lasting impairment following nonfatal drowning (5). Most child injury mortality can be prevented by taking appropriate precautions and implementing safety systems appropriate to the environment. Therefore, it would be helpful to analyze the age- or region-related causes of pediatric drowning in Korea. However, most pediatric drowning research has been conducted in the Seoul metropolitan area or in areas adjacent to the sea (6).

Drowning accidents in the Yeongseo region of Gangwon Province are expected to show different patterns from the accidents in the Yeongdong region, the other part of the province, particularly the east coast. The Yeongseo region boasts numerous recreational facilities. With the proliferation of private water play culture, many swimming pools have been built within accommodations, such as pool villas, in the region. However, for these facilities, current safety regulations are inadequate and are not subject to the Sports Facilities Act. Accordingly, there are cases where the lack of mandatory safety equipment, such as life jackets, is not a legal issue. This structural issue, coupled with the limited number of observers monitoring children on private family trips, can lead to drowning accidents if children are left unsupervised, even for a short time, near pool villas or other pools.

In this research environment, we aimed to analyze age group-related characteristics in the northern part of Yeongseo, Gangwon Province, which has been a poorly studied inland area, as well as the reasons for its worse outcomes.

Methods

This study included patients aged 19 years or younger who were diagnosed with drowning at Kangwon National University Hospital from January 1, 2020 through July 20, 2025. This study was approved by the institutional review board of the hospital with a waiver for informed consent (IRB no. KNUH-2025-07-027). Relevant diagnoses were identified using the International Classification of Diseases, 10th Revision codes for “drowning” or “submersion.” A worse outcome was defined as hospitalization to the intensive care unit (ICU; see hospitalization criteria in Appendix [https://doi.org/10.22470/pemj.2025.01487]) or in-hospital mortality. Otherwise, outcomes were considered “better.” For example, patients who underwent noninvasive oxygen therapy were considered to have better outcomes.

We collected data related to the following variables, including: sex, age group (<1, 1-4, 5-9, 10-14, and 15-19 years), season of visit (spring [March-May], summer [June-August], fall [September-November], and winter [December-February]), implementation of bystander cardiopulmonary resuscitation, guardian’s negligence (neglect of a minor without adequate safety measures, based on medical records), submersion time (<1, 1-5, and >5 minutes), suicide attempt, location (home, commercial swimming pool, and river), time taken by 119 emergency medical service providers (EMSPs) to arrive at the scene or at the ED, initial Korean Triage and Acuity Scale score assigned at the ED (7), coverage of relevant costs by the National Health Insurance, implementation of oxygen therapy (overall, the use of nasal cannula, mask, or high flow nasal cannula) and positive pressure ventilation, and initial laboratory finding. The laboratory findings included leukocyte count with neutrophil percentage (%), concentrations of hemoglobin, glucose, urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, natrium, kalium, chloride, C-reactive protein, and findings of venous blood gas analysis (pH, PCO₂, HCO₃⁻, and base deficit).

In the statistical analysis, continuous variables were assessed using the Mann-Whitney U-tests when the Shapiro-Wilk tests indicated non-normality (P <0.05); categorical variables were analyzed using the chi-square tests. The abovementioned variables were compared between the better and worse outcome groups. All analyses were performed using IBM SPSS ver. 26 (IBM Corp.).

Results

1. Clinical characteristics

During the study period, 27 patients who underwent drowning accidents were treated at the hospital, of whom 11 had the worse outcomes, including 9 ICU hospitalizations and 4 in-hospital mortalities. All accidents occurred in freshwater. Table 1 summarizes the comparison of the clinical features as per the presence of the worse outcomes. Guardian’s negligence was observed in 74.1% overall, 56.3% in the better outcome group versus 100% in the worse outcome group (P = 0.013). Regarding the age groups, patients aged 1-4 years were most common overall, while in the worse outcome group, those aged 5-9 years were most common, followed by those aged 1-4 years. Summer (19 [70.4%]) was the most common season when the patients visited, followed by spring (3 [11.1%]), fall (3 [11.1%]), and winter (2 [7.4%]), with no group difference (better vs. worse: spring, 2 [12.5%] vs. 1 [9.1%]; summer, 10 [62.5%] vs. 9 [81.8%]; fall, 2 [12.5%] vs. 1 [9.1%]; and winter, 2 [12.5%] vs. 0 [0%]).

Table 1.

Comparison of the clinical findings as per the worse outcomes

Bystander cardiopulmonary resuscitation was performed in 74.1% of cases (Table 1). The mean submersion time was 6.6 ± 11.5 minutes. The most common submersion time interval was 1-5 minutes (59.3%). Altered mental status was found in 25.9%, exclusive to the worse outcome group (P < 0.001). In contrast, suicide attempts (18.5%) were exclusively found in the better outcome group (P = 0.040). Regarding the location, about 85% of the patients were submerged in rivers or pools, with the pools more frequent in the worse outcome group (rivers, P = 0.048; pools, P = 0.022). Ten of the 12 patients who were submerged in the pools underwent submersions in pensions with private pools. A mean time for the 119 EMSPs to arrive at the scene was 11.3 ± 5.5 minutes (better, 10.4 ± 5.3 minutes vs. worse, 12.6 ± 5.5 minutes; P = 0.406), while that for them to arrive at the ED was 56.0 ± 24.9 minutes (better, 56.5 ± 23.5 minutes vs. worse, 55.2 ± 26.7 minutes; P = 0.917). A mean initial Korean Triage and Acuity Scale score was lower (i.e., higher acuity) in the worse outcome group than in the counterpart (P = 0.006). All patients’ medical costs were covered by the National Health Insurance.

Seven of the 20 patients younger than 15 years resided in Gangwon Province, while 6 of the 7 patients aged 15 years and older lived in the province. Twenty-six patients (96.3%) were transported by 119 EMSPs. Two patients died out of 7 patients aged 15 years or older (28.6%), and out of 20 patients aged 15 years or younger (10.0%), respectively. Nine of the 27 patients (33.3%) were hospitalized to the ICU. A mean length of stay in the ICU was 7 ± 12 days, while a mean length of stay in the general ward was 5 ± 9 days.

3. Therapeutic interventions and laboratory findings

All patients in the worse outcome group required oxygen therapy (P <0.001; Table 2). Positive pressure ventilation, such as synchronized intermittent mandatory ventilation or bag-mask ventilation, was more frequently performed in the same group (P = 0.002). Mean concentrations of glucose, urea nitrogen, aspartate aminotransferase, and base deficit were significantly higher in the worse outcome group compared with the better outcome group, while a chloride concentration was lower in the former group (Table 3).

Table 2.

Comparison of treatment according to the worse outcomes

Table 3.

Comparison of laboratory findings as per the worse outcomes

Discussion

This study shows the causes of drowning accidents varied by the age group; however, the accidents in pools frequently occurred in preschool- or school-aged children, with fatal outcomes or irreversible brain damage relatively common (see the “1. Clinical characteristics” section). In infants, the most common location was bathtub (see the “2. Locations of drowning accidents by the age group” section). In contrast, for those aged 15 years and older, it was common to observe drowning in river water for suicidal purposes. This differs from Korean nationwide statistics on the causes of childhood drowning (4). A possible reason is that the northern Yeongseo region is not connected to the sea. Additionally, many private and corporate recreational facilities, including pools, are located in nearby areas, such as Gapyeong in Gyeonggi Province and Hongcheon in Gangwon Province.

In drowning accidents, submersion time is the strongest outcome predictor (8-10). However, there was no difference between the 2 groups in transport time to the ED (see details in the results). A previous study by Cho et al. (11) found no correlation between transfer time and final outcomes, supporting the findings of this study. Drowning is a critical prognostic factor because water entering the airway causes airway obstruction and subsequent hypoxia (12). This suggests that measures to manage hypoxia, such as oxygenation, are more effectively implemented by emergency medical technicians, such as 119 EMSPs, than by bystanders. Hence, the proximity of 119 ambulances to the scene is considered more important than accessibility to hospitals for a better outcome in pediatric drowning accidents.

Submersion time tended to be shorter in the better outcome group where infants accounted for 18.8% than in the worse outcome group where they comprised 9.1% (Table 1). As a result, the former group required less frequent oxygen therapy. As a countermeasure, public awareness campaigns should educate guardians to supervise bathing (13). Considering the frequent suicide attempts in patients aged 15 years and older, it may be important that preventive measure focuses on strengthening mental health monitoring and expanding psychiatric services for youth, rather than limiting such measures to drowning per se.

Most drowning accidents involving preschool- and school-aged children in the region occurred in pools, resulting in worse outcomes, suggesting the need for strengthened safety measures for such a high-risk situation. The World Health Organization recommends the following community-based activities to prevent drowning (2), such as the installation of barriers to control water access. In this study, more accidents occurred when caregivers were distracted than when children voluntarily entered the water, suggesting that this could be prevented. We believe that continuously raising awareness and highlighting that even a moment of carelessness can lead to irreversible consequences in pediatric drowning accidents will contribute to further reduction of these tragic incidents.

This study has some limitations. First, it is limited to data obtained from a single center in the northern Yeongseo region of Gangwon Province, making it difficult to generalize to the nationwide drowning situation. Second, the study period included the coronavirus disease 2019 pandemic period when people were advised to refrain from unnecessary travel. This feature suggests that the actual number of drowning incidents may have been lower than predicted during the pandemic.

In conclusion, this study on pediatric drowning patients at a university hospital in the northern Yeongseo region of Gangwon Province showed the most frequent locations, which were the bathtub at home in infants, pool in children, and river in adolescents, and clinical features related to the worse outcomes. These findings need to be considered for prompting increased parental vigilance and more comprehensive societal preventive measures.

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