Predicting discharge in uncomplicated near-drowning

To determine if routine, noninvasive parameters could be measured which pre dict early (4-6 hour) discharge from the emergency department (ED) in mildl y symptomatic and asymptomatic victims of childhood near-drowning, a retros pective cohort study was undertaken, Patients with fresh water near-drownin g were studied over a 3-year period who presented with Glascow Come Scale ( GCS) greater than or equal to 13 and required no advanced life support prio r to or less than or equal to 4 hours after ED presentation. Three groups o f patients were found: 39 patients (81%) had normal pulmonary examination ( PEx) and normal room air oxygen saturation (RASaO(2)) by 4 to 6 hours and d id not deteriorate during the hospital admission (<24 hours); 5 patients (1 0%) had normal PEx by 4 to 6 hours and RASaO(2) by 8 to 12 hours and did no t deteriorate during hospitalization (<24 hours). Four patients (8%) were h ospitalized for more than 24 hours, No patient with normal RASaO(2) at 6 ho urs deteriorated while in the hospital (Cl 92.3-100%), Children who present to the ED with GCS greater than or equal to 13 and have normal PEx/respira tory effort and RA-SaO(2) more than 95% at 4 to 6 hours after ED presentati on can be safely discharged home. Copyright (C) 2000 by W.B. Saunders Compa ny.