Freshwater submersion injuries in children: A retrospective review of seventy-five hospitalized patients

Objective. To determine whether or not selected victims of submersion accidents can be safely managed as outpatients. Design.Retrospective chart review. Setting. Children's Medical Center of Dallas. Patients. One hundred forty-eight charts reviewed, comprising all hospital admissions after submersion accidents from April 1987 to April 1994. Results. Of the 148 patient charts that were reviewed, 73 patients were excluded from the study for the following criteria: endotracheal intubation before initial medical evaluation; transfer form an inpatient unit of another medical facility; history of preexisting neurologic, neurodevelopmental, and/or pulmonary disease. Of the 75 evaluable patients, 3 were directly admitted to the inpatient service with no documented initial medical evaluation reported in the medical record. Of the remaining 72 patients, 62 (86%) were symptomatic at the time of the initial medical evaluation in the emergency department; 10 patients (14%) were asymptomatic. Seventy percent of the initially asymptomatic patients and 57% of patients who were symptomatic at the time of initial medical evaluation were asymptomatic by 8 hours after the submersion event. By 18 hours postsubmersion, all patients who were initially asymptomatic and 72% of initially symptomatic patients were normal. Thirty- five percent and 80% of patients who had abnormal initial physical examinations and abnormal chest x-rays had a normal physical examination by 8 hours and 18 hours, respectively, and all remained normal. Conclusions. Routine hospital admission of all children who have had immersion accidents is unnecessary.