Predictors of safe discharge for pediatric drowning patients in the emergency department

Title: Predictors of safe discharge for pediatric drowning patients in the emergency department
Authors: Courtney E. Brennan, Travis K.F. Hong, Vincent J. Wang
Journal: The American Journal of Emergency Medicine, Jan 2018

This is the second article on this topic within the past 6 months. This is great to see as the evidence concerning this important topic is scant.

Study Aim

"determine if pediatric drowning patients who are well-appearing with normal age-adjusted vital signs and pulse oximetry at presentation to the emergency department can be safely discharged without admission or a prolonged observation period."

Methods

• Retrospective chart review of all pediatric patients with discharge diagnosis of drowning, near drowning, or submersion injury, 1995-2014
• Excluded patients transferred in, with significant comorbids, distracting injuries, or GCS < 14

Results

• 180 patient included
• Mean age 2.94 years
• 64% males
• Majority of drownings in pools
• Submersion time known 66%, all less than 5 minutes
• Findings
• No correlation between age, submersion time, apneic time, resus time, and disposition
• 34% had normal age-adjusted initial vital signs and pulse oximetry on arrival
• One of these patients had clinical decline and had grunting respirations within 1 hour of presentation.
• 52% of patients in the study admitted to the hospital
• 8 of these patients had clinical decline
• All experienced decline within 1 hour of presentation
• None of these patients required more than supplement oxygen
• All returned to baseline before discharge
• 2 of these patients had normal vital signs on presentation
• Both developed grunting within 1 hour
• Abnormal vital signs on presentation not associated with decline
• Those with decline more likely to have abnormal pulse ox on arrival
• 48% discharged from emergency department
• 2 had return visits within 3 days, both discharged from department same day

Bottom Line

While small in nature, this study adds much needed evidence to an important and not well-studied topic. The most important result of this study is that it helps confirm what we have found in similar studies: patients presenting to the emergency department following drowning who are initially stable and mentating well tend to do well, and if they decline they do so within first 4-8 hours.

Reference

Brennan C, Hong T, Wang V. Predictors of safe discharge for pediatric drowning patients in the emergency department. Am J Emerg Med. 2018 Jan.