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Predicting discharge in uncomplicated near-drowning
A L Causey1, J A Tilelli, M E Swanson
1Emergency Associates for Medicine and University of South Florida College of Medicine, Tampa, USA. causeya@chkd.com
The American Journal of Emergency Medicine
|February 16, 2000
Summary
Mildly symptomatic children who survive near-drowning incidents can be safely discharged early if they show normal respiratory effort and oxygen saturation levels within 4-6 hours. This finding aids in determining appropriate emergency department discharge criteria for pediatric near-drowning cases.
Area of Science:
- Pediatric Emergency Medicine
- Toxicology
- Cardiopulmonary Physiology
Background:
- Near-drowning incidents in children pose a significant challenge for emergency department (ED) management.
- Predicting safe early discharge is crucial for resource optimization and reducing healthcare burdens.
- Current guidelines for pediatric near-drowning patient disposition require further refinement based on objective parameters.
Purpose of the Study:
- To identify routine, noninvasive clinical parameters for predicting early discharge (4-6 hours) in pediatric near-drowning victims.
- To evaluate the safety and efficacy of early discharge protocols for mildly symptomatic or asymptomatic near-drowning patients.
- To establish reliable indicators for hospital admission versus immediate discharge following near-drowning events.
Main Methods:
- A retrospective cohort study was conducted over three years.
- Inclusion criteria included fresh water near-drowning, Glasgow Coma Scale (GCS) score ≥13, and no need for advanced life support within 4 hours of ED presentation.
- Patients were monitored for pulmonary examination (PEx), room air oxygen saturation (RASaO2), and clinical deterioration.
Main Results:
- 81% of patients (n=39) had normal PEx and RASaO2 within 4-6 hours and were discharged in <24 hours.
- 10% of patients (n=5) required 8-12 hours for normal RASaO2 but were also discharged in <24 hours.
- No patient with a normal RASaO2 at 6 hours deteriorated during hospitalization (95% confidence interval: 92.3-100%).
Conclusions:
- Children with GCS ≥13 presenting after near-drowning, exhibiting normal pulmonary examination and respiratory effort, can be safely discharged.
- A room air oxygen saturation (RA-SaO2) >95% at 4-6 hours post-ED presentation is a reliable indicator for safe discharge.
- These findings support the use of objective clinical parameters for early discharge decisions in pediatric near-drowning cases, improving ED efficiency.