Sunday, February 4, 2018

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."

  • 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
  • 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.