Saturday, October 28, 2017

Predictors of emergency department discharge following pediatric drowning


Title: Predictors of emergency department discharge following pediatric drowning
Authors: Cantu R, Pruitt C, Samuy N, Wu C
Journal: American Journal of Emergency Medicine (Aug 2017)

When it comes to treating pediatric drowning patients in the Emergency Department, one of the toughest (and scariest) decisions is whether to send the well-appearing patient home or not. The evidence supporting these decisions is fairly weak, with 3 small retrospective studies providing most of the data. This article adds a small but significant piece to the puzzle.

Study Aim:
" ...our study aims to identify predictors of discharge in children presenting to the ED after accidental drowning. "

Methods

  • Single Pediatric Emergency Department (ED), all drowning patients over 4 years
  • Retrospective review to determine disposition (discharge, admission, death)
  • Secondary review to determine any follow-up at 7 or 30 days
Results
  • 90 total patients included (48% age 1-5)
    • 37% of patients discharged from ED
    • 1 patient died in ED
    • 63% of patients admitted (26% to ICU)
  • 3 patients re-admitted within 7 days
    • none related to drowning incident
  • 2 patients re-admitted within 30 days
    • 1 feeding tube dislodged, one femur fracture unrelated to drowning
  • Radiography
    • 25% of patients had abnormal chest imaging
    • 4% of patients had abnormal initial head CTs

  • Independent predictors of safe discharge
    • Lack of hypoxia in ED
    • Lack of field intervention
    • Normal Chest X-ray
    • No blood gas testing
While not the strongest study, owing to it's single-center, retrospective nature and small population, it does add to the small field of evidence to help support ED disposition of drowning patients. Only a minority of the patients studied were actually discharged from the ED, but those who were did not return for worsening morbidity associated with the event.

Reference


Sunday, October 1, 2017

Bystander CPR is associated with improved neurologically favourable survival in cardiac arrest following drowning

Title: Bystander CPR is associated with improved neurologically favourable survival in cardiac arrest following drowning

Authors: Joshua M. Tobin, William D. Ramos, Yongjia Pu, Peter G. Wernicki,
Linda Quan, Joseph W. Rossano

Journal: Resuscitation, June 2017


Long term prognosis following a drowning cardiac arrest is always difficult, multiple studies have found little consistent correlation with scene and clinical findings and outcome. One factor that is often studied with any type of cardiac arrest is bystander CPR, as the earlier CPR is started the better the patient should do. This study is aimed at determining factors associated with good neurologic outcome following drowning cardiac arrest.

Study details

Method: Retrospective analysis of CARES database

  • All patients who suffered drowning cardiac arrest
  • Stratified bystander CPR vs no bystander CPR
  • Multi-variate analysis: bystander CPR, AED use, location, gender, witnessed status, shockable rhythm, age
  • Survivors stratified by neurologic outcome

Results
  • 908 patients included
  • Bystander CPR in 428 (47%)
  • Majority of cases no AED
  • Majority of the cases male, unwitnessed, in public place
  • First rhythm non-shockable in 93%
  • 123 patients survived to discharge (14%)
    • 97 (80%) favorable neuro outcome
    • Associated with favorable outcome: bystander CPR, witnessed, younger
    • Not associated with favorable outcome: Public, male, shockable rhythm
Conlusion

"Bystander CPR is associated with improved neurologic outcome following cardiac arrest from drowning. Shockable rhythms were uncommon and not associated with improved outcomes."


Reference