Predictors of safe discharge for pediatric drowning patients in the emergency department

Courtney E. Brennan, Travis K.F. Hong, Vincent J. Wang

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: The purpose of this study is to determine if stable, well-appearing, drowning patients who have normal age-adjusted vital signs and pulse oximetry upon arrival to the emergency department may be safely discharged without a prolonged observation period. Methods: Medical records were retrospectively reviewed for drowning patients presenting to a single pediatric emergency department from 1995 to 2014. Data were collected on vital signs and pulse oximetry at presentation, chest x-ray results, disposition and complications for each encounter. Patients were identified as having either normal or abnormal initial vital signs and pulse oximetry, and were compared based on disposition and complication rates. Results: Two hundred seventy-six records were initially evaluated and 91 were excluded. Thirty-six percent had normal age-adjusted vital signs upon arrival. Patients with abnormal temperature, respiratory rate or pulse oximetry, as well as those with any abnormal initial cardiopulmonary physical exam findings, abnormal mental status, or chest radiograph findings, were more likely to be admitted to the hospital. Eight patients developed respiratory complications after presentation to the emergency department. Those with abnormal pulse oximetry readings on arrival were more likely to develop complications. Only two patients who developed complications had initially normal vital signs and each had evidence of clinical deterioration within 1 h of arrival. Conclusions: The overall complication rate in initially stable, well-appearing drowning patients is low. An abnormal pulse oximetry reading at presentation may help predict subsequent complications. Those patients with normal age-adjusted vital signs and physical exam at presentation may not require a prolonged observation period.

Original languageEnglish (US)
Pages (from-to)1619-1623
Number of pages5
JournalAmerican Journal of Emergency Medicine
Volume36
Issue number9
DOIs
StatePublished - Sep 2018
Externally publishedYes

Fingerprint

Oximetry
Vital Signs
Hospital Emergency Service
Pediatrics
Reading
Thorax
Observation
Respiratory Rate
Medical Records
X-Rays
Temperature

Keywords

  • Drowning
  • Pediatrics
  • Submersion injury

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Predictors of safe discharge for pediatric drowning patients in the emergency department. / Brennan, Courtney E.; Hong, Travis K.F.; Wang, Vincent J.

In: American Journal of Emergency Medicine, Vol. 36, No. 9, 09.2018, p. 1619-1623.

Research output: Contribution to journalArticle

@article{9f162ac659b3450981c85ab9cbe96ebe,
title = "Predictors of safe discharge for pediatric drowning patients in the emergency department",
abstract = "Objectives: The purpose of this study is to determine if stable, well-appearing, drowning patients who have normal age-adjusted vital signs and pulse oximetry upon arrival to the emergency department may be safely discharged without a prolonged observation period. Methods: Medical records were retrospectively reviewed for drowning patients presenting to a single pediatric emergency department from 1995 to 2014. Data were collected on vital signs and pulse oximetry at presentation, chest x-ray results, disposition and complications for each encounter. Patients were identified as having either normal or abnormal initial vital signs and pulse oximetry, and were compared based on disposition and complication rates. Results: Two hundred seventy-six records were initially evaluated and 91 were excluded. Thirty-six percent had normal age-adjusted vital signs upon arrival. Patients with abnormal temperature, respiratory rate or pulse oximetry, as well as those with any abnormal initial cardiopulmonary physical exam findings, abnormal mental status, or chest radiograph findings, were more likely to be admitted to the hospital. Eight patients developed respiratory complications after presentation to the emergency department. Those with abnormal pulse oximetry readings on arrival were more likely to develop complications. Only two patients who developed complications had initially normal vital signs and each had evidence of clinical deterioration within 1 h of arrival. Conclusions: The overall complication rate in initially stable, well-appearing drowning patients is low. An abnormal pulse oximetry reading at presentation may help predict subsequent complications. Those patients with normal age-adjusted vital signs and physical exam at presentation may not require a prolonged observation period.",
keywords = "Drowning, Pediatrics, Submersion injury",
author = "Brennan, {Courtney E.} and Hong, {Travis K.F.} and Wang, {Vincent J.}",
year = "2018",
month = "9",
doi = "10.1016/j.ajem.2018.01.050",
language = "English (US)",
volume = "36",
pages = "1619--1623",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",
number = "9",

}

TY - JOUR

T1 - Predictors of safe discharge for pediatric drowning patients in the emergency department

AU - Brennan, Courtney E.

AU - Hong, Travis K.F.

AU - Wang, Vincent J.

PY - 2018/9

Y1 - 2018/9

N2 - Objectives: The purpose of this study is to determine if stable, well-appearing, drowning patients who have normal age-adjusted vital signs and pulse oximetry upon arrival to the emergency department may be safely discharged without a prolonged observation period. Methods: Medical records were retrospectively reviewed for drowning patients presenting to a single pediatric emergency department from 1995 to 2014. Data were collected on vital signs and pulse oximetry at presentation, chest x-ray results, disposition and complications for each encounter. Patients were identified as having either normal or abnormal initial vital signs and pulse oximetry, and were compared based on disposition and complication rates. Results: Two hundred seventy-six records were initially evaluated and 91 were excluded. Thirty-six percent had normal age-adjusted vital signs upon arrival. Patients with abnormal temperature, respiratory rate or pulse oximetry, as well as those with any abnormal initial cardiopulmonary physical exam findings, abnormal mental status, or chest radiograph findings, were more likely to be admitted to the hospital. Eight patients developed respiratory complications after presentation to the emergency department. Those with abnormal pulse oximetry readings on arrival were more likely to develop complications. Only two patients who developed complications had initially normal vital signs and each had evidence of clinical deterioration within 1 h of arrival. Conclusions: The overall complication rate in initially stable, well-appearing drowning patients is low. An abnormal pulse oximetry reading at presentation may help predict subsequent complications. Those patients with normal age-adjusted vital signs and physical exam at presentation may not require a prolonged observation period.

AB - Objectives: The purpose of this study is to determine if stable, well-appearing, drowning patients who have normal age-adjusted vital signs and pulse oximetry upon arrival to the emergency department may be safely discharged without a prolonged observation period. Methods: Medical records were retrospectively reviewed for drowning patients presenting to a single pediatric emergency department from 1995 to 2014. Data were collected on vital signs and pulse oximetry at presentation, chest x-ray results, disposition and complications for each encounter. Patients were identified as having either normal or abnormal initial vital signs and pulse oximetry, and were compared based on disposition and complication rates. Results: Two hundred seventy-six records were initially evaluated and 91 were excluded. Thirty-six percent had normal age-adjusted vital signs upon arrival. Patients with abnormal temperature, respiratory rate or pulse oximetry, as well as those with any abnormal initial cardiopulmonary physical exam findings, abnormal mental status, or chest radiograph findings, were more likely to be admitted to the hospital. Eight patients developed respiratory complications after presentation to the emergency department. Those with abnormal pulse oximetry readings on arrival were more likely to develop complications. Only two patients who developed complications had initially normal vital signs and each had evidence of clinical deterioration within 1 h of arrival. Conclusions: The overall complication rate in initially stable, well-appearing drowning patients is low. An abnormal pulse oximetry reading at presentation may help predict subsequent complications. Those patients with normal age-adjusted vital signs and physical exam at presentation may not require a prolonged observation period.

KW - Drowning

KW - Pediatrics

KW - Submersion injury

UR - http://www.scopus.com/inward/record.url?scp=85041920536&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041920536&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2018.01.050

DO - 10.1016/j.ajem.2018.01.050

M3 - Article

C2 - 29452918

AN - SCOPUS:85041920536

VL - 36

SP - 1619

EP - 1623

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

IS - 9

ER -