Child Drowning

certified in the detailed coding procedures for ICD classification are usually only at the top level of the
national hospital system. They are absent at community-level urban health centres and village clinics,
where almost all drowning mortality actually occurs and where the details surrounding the drowning,
required for correct coding, are known. Lacking trained coders at the lowest level where most
drownings occur, the death often goes unrecorded. Where it is recorded, the lack of trained coders
often results in incorrect, inaccurate or incomplete coding.
In the mid-1990s, the tenth version of the ICD was introduced. ICD-10 brought a major increase in
coding complexity, doubling the number of codes to about 18,000. The migration from ICD 9 to ICD 10
required enormous resource commitments that many LMICs lacked. The new version required replacing
reporting forms, retraining of all coders, supervisors and trainers. It rendered many of the previous
classifications obsolete, causing comparability issues with data from previous years. In particular, the
changes in coding for drowning raised questions because ICD-10 drowning codes are not mutually
exclusive. This can result in duplicate counting, creating potential problems in determining incidence of
drowning events. 8 Further potential for incomparability exists with the upcoming revision. ICD-11,
planned for 2015 has major changes in codes and classification structures which will further complicate
any transition. As a result, many countries have not adopted ICD-10 and continue to use ICD-9.
For countries using ICD-9, the drowning codes focus on the recreational activity undertaken at the time
of the drowning event (see Table 1). The categories are mainly applicable to HICs. Recreational activities
such as water skiing and sport, or recreational activity with diving equipment are not relevant to LMICs.
The table also includes a code for drowning in the bathtub. Rural homes in LMICs generally do not have
bathtubs, making this category irrelevant for the great majority of cases of drowning in LMICs. Using
ICD-9, even when reported, virtually all drowning would be classified as ‘other’, or ‘unspecified place of
occurrence code’. This has led users to question the utility of the classification system, which is a major
disincentive to complete and correct coding.
Table 1: ICD-9 codes for drowning (1992)
E910
Accidental drowning and submersion
E910.0 While water-skiing
E910.1 While engaged in other sport or recreational activity with diving equipment
E910.2 While engaged in other sport or recreational activity without diving
E910.3 equipment While swimming or diving for purposes other than recreation or sport
E910.4 In bathtub
E910.8 Other
E910.9 Unspecified place of occurrence code
One result of the change to ICD-10 was a change in focus for the mechanism of drowning (e.g. falling
into a swimming pool versus being in the swimming pool, or falling into a bathtub versus being in the
bathtub). The nature of the activity in the water body changed as well from ICD-9 to ICD-10 with waterskiing,
other water sports, recreation and diving no longer mentioned. In ICD-10, the three digit codes
(W65-W74) refer to the act of falling into water or being in the water as seen in table 2 below.
8 Langley J.D. and D. J. Chalmers (1999). ‘Coding the circumstances of injury: ICD-10 a step forward or backwards?’ Injury
Prevention, 5:247-253.
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