Predicting discharge in uncomplicated near-drowning.
To determine if routine, noninvasive parameters could be measured which predict early (4-6 hour) discharge from the emergency department (ED) in mildly symptomatic and asymptomatic victims of childhood near-drowning, a retrospective cohort study was undertaken. Patients with fresh water near-drowning were studied over a 3-year period who presented with Glascow Come Scale (GCS) > or =13 and required no advanced life support prior to or < or =4 hours after ED presentation. Three groups of patients were found: 39 patients (81%) had normal pulmonary examination (PEx) and normal room air oxygen saturation (RASaO2) by 4 to 6 hours and did not deteriorate during the hospital admission (<24 hours); 5 patients (10%) had normal PEx by 4 to 6 hours and RASaO2 by 8 to 12 hours and did not deteriorate during hospitalization (<24 hours). Four patients (8%) were hospitalized for more than 24 hours. No patient with normal RASaO2 at 6 hours deteriorated while in the hospital (CI 92.3-100%). Children who present to the ED with GCS > or =13 and have normal PEx/respiratory effort and RA-SaO2 more than 95% at 4 to 6 hours after ED presentation can be safely discharged home.
Causey
A L
AL
Emergency Associates for Medicine and University of South Florida College of Medicine, Tampa, USA. causeya@chkd.com
Tilelli
J A
JA
Swanson
M E
ME
D000293:Adolescent; D001784:Blood Gas Analysis; D002648:Child; D002675:Child, Preschool; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate; D006801:Humans; D007223:Infant; D008297:Male; D015701:Near Drowning / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D010100:Oxygen / Q000097:blood; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D015656:Respiratory Mechanics; D012189:Retrospective Studies; D013997:Time Factors
D010100:Oxygen