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