Incidence of "secondary drowning" after saltwater submersion

Most authorities recommend admission of all near-drowning victims out of fear of "secondary drowning." Identifying victims at risk could promote vigorous evaluation and reduce unnecessary hospitalization. We prospectively studied 52 swimmers with symptoms of respiratory distress after submersion. Thirty-one (60%) were released on the beach, and none of 26 followed up by telephone sought medical care or exhibited symptoms of respiratory distress as many as five days later. Twenty-one patients (40%) were transported to a hospital for further evaluation. All who required admission displayed signs of respiratory distress within four hours. No patient developed "secondary drowning" after an asymptomatic interval, indicating that emergency department observation for four to six hours could effectively screen for those patients requiring inpatient therapy. We question the existence of "secondary drowning" as anything other than established, detectable respiratory insufficiency.