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

Objectives: The purpose of this study is to determine if stable, well-appearing, drowning patients who have normal age-adjusted vital signs and pulse oximetry upon arrival to the emergency department may be safely discharged without a prolonged observation period. Methods: Medical records were retrospectively reviewed for drowning patients presenting to a single pediatric emergency department from 1995 to 2014. Data were collected on vital signs and pulse oximetry at presentation, chest x-ray results, disposition and complications for each encounter. Patients were identified as having either normal or abnormal initial vital signs and pulse oximetry, and were compared based on disposition and complication rates. Results: Two hundred seventy-six records were initially evaluated and 91 were excluded. Thirty-six percent had normal age-adjusted vital signs upon arrival. Patients with abnormal temperature, respiratory rate or pulse oximetry, as well as those with any abnormal initial cardiopulmonary physical exam findings, abnormal mental status, or chest radiograph findings, were more likely to be admitted to the hospital. Eight patients developed respiratory complications after presentation to the emergency department. Those with abnormal pulse oximetry readings on arrival were more likely to develop complications. Only two patients who developed complications had initially normal vital signs and each had evidence of clinical deterioration within 1 h of arrival. Conclusions: The overall complication rate in initially stable, well-appearing drowning patients is low. An abnormal pulse oximetry reading at presentation may help predict subsequent complications. Those patients with normal age-adjusted vital signs and physical exam at presentation may not require a prolonged observation period.