After road traffic injuries, drowning is the second leading cause of unintentional injury death worldwide  and therefore a constant problem of the global burden of disease . The past decades of research in the field of drowning have been challenged by revolutionary insights in pathogenesis and therapy of drowning victims. Despite its continuing actuality and the notable effort in drowning research, it is still a doggerel medical topic with only few preventive medical approaches. Therefore, further investigations are necessary in order to enable and promote understandings concerning the condition drowning. The present study represents the first bibliometric review of worldwide research activities on the subject of drowning.
Regarding the results of the language analysis, it is confirmed that with English as international voice of medicine it is possible for scientists to attract a big audience whereas other languages experience a loss of importance [23, 24]. The subsequent rise of impact factors of English language journals results in turn in more citations which leads to a language bias  which is also supported by the fact that the ten most productive journals publishing on the subject drowning are in English language without exception. Analyzing the cartograms, productive countries, e.g. the USA and European states, show low drowning rates compared to developing and industrializing states, e. g. Asian and African countries, where most drowning incidents occur. It could be concluded that the amount of drowning rates and the the total number of drowning victims reflect a global marker of deficits in health and social policies. In first world countries there are a better public education and perception on drowning risks, more efficient preventive measurements and better therapeutic options. This could be a one possible explanation for the low number of drowing victims in first world countries. The author analysis showed that an author's research producitvity (number of publications) does not necessarily correlate with the scientific calue of the author's work (citation rate). Consonant with the leading role of the USA in reseraching drowning in general, more than half of the most productive authors originate from this nation.
It has to be considered that the analysis of drowning related artivles in the present study cannot be regarded as completely representative of global occupational research activity in this filed, since the data was retrieved from only one database (Web of Science), denoting a potential bias. Whereas the Web of Science is among the largest global biomedical databases, there are still publications which cannot be traced by the use of this system. Nonetheless, it can be hypothesized that the present findings represent common trends in the research of drowing. In addition, the employed quality indicators need to be regarded critically and therefore, the data should not be over interpreted as indicated by numerous previous articles [26–28]. Furthermore, the drowning data retrieved from the WHO do not exactly display the actual number of drowning victims. According to estimations, it is much higher because the number of near-drowning victims  and drownings due to cataclysms, water and other transport accidents, assaults and suicide are excluded . Also the clinical symptoms cannot be related to a certain disease according to the ICD because of the huge variability resulting in a complicated documentation because the chain of causation is unclear: For example, death from drowning would also be the ruling for a drowing victim who develops and dies from aspiration pneumonia after being stable withsevere hypoxic encephalopathy for weeks to months. However, if that same patient died of acute myocardial infarcion, it most likely would be classified as a death not related to drowning . Another reason for underreporting is a lack of standardized definitions within the terminology of drowning . The new, more appropriate, world-wide uniform definition of drowning demanded was finally presented on the World Congress on Drowning in 2002: "Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid" . This definition was also seized for the "Utstein Style", i. e. recommended guidelines for uniform reporting of data from drowning  to provide adaquate and reliable international registrations of drowning incidents.
It is interesting to compare the present results to other studies in the field of health geographics recently published [32, 33]. For instance, Boulos published a study on geography and medical journalology. He focussed on the geographical distribution of articles published in the leading medical informatics journal Medical Informatics & the Internet in Medicine between 1999 and 2004 . It was shown that the examined journal had an international outreach, with authors from 24 countries, spanning four continents . European articles with 81.25% of all articles counted dominated the study. In specific, articles from the UK (15.63%) and Greece (15.63%) were numerous . There were no contributions from Africa or South America present. This finding within the field of medical informatics is differing to the present results found for the field of drowning research in which the United States of America is the country with the highest output of articles.
A further study published by Uthman and Uthman focussed on the research activity in a singly continent, Africa . Analysing articles indexed by PubMed between 1996 and 2005 it was demonstrated that biomedical research production in Africa is highly skewed . South Africa, Egypt, and Nigeria were found to make up a striking 60% of the total number of articles. The authors also adjusted for population size and reported that smaller countries, such as The Gambia, Gabon and Botswana, were more productive in relation to Nigeria and Kenya . The Gambia and Eritrea had better records when total production was adjusted for gross domestic product. The contribution of Africa to global research production was persistently low through the period studied . Our present data in the field of drowning research is in aggreement with this specific set of data recorded only for Africa and biomedical research activity.