Criteria for early discharge of drowning patients from the emergency department

Abstract

Objective

Clinical factors previously shown to independently predict safe discharge were applied at ED presentation to determine whether we could identify a group of drowning patients who do not require treatment and are thus safe for rapid discharge.

Method

We conducted a retrospective study of drowning presentations to EDs of the Sunshine Coast Hospital and Health Service in Queensland, Australia between 1 January 2015 and 31 December 2022. Rapid discharge criteria (RDC) were defined as a normal spontaneous respiratory rate (adjusted for age), a normal peripheral blood saturation (≥94%) on room air, an Alert measurement on the Alert, Voice, Pain, Unresponsive scale, clear chest auscultation and the absence of any requirement for oxygen or other ventilatory assistance from Emergency Medical Services. Primary outcome was the requirement for treatment (oxygen, ventilation or airway intervention).

Results

Five hundred and seventy-seven drowning presentations were included. Two hundred and fifty-five (44.2%) patients met RDC at ED presentation. Patients meeting RDC were more likely to be younger (median 9 years, IQR 3–21 vs 20 years, IQR 4–44, P < 0.016) than those with not meeting RDC. Eight patients meeting RDC had received bystander CPR. There were no deaths in the RDC group (0/255 (0%) vs 17/322 (5.3%), P < 0.016). No patient meeting RDC required treatment (0/255 (0%) vs 145/322 (45.0%), P < 0.016).

Conclusions

Drowning patients who meet rapid discharge criteria at ED presentation will not require treatment for their drowning and may be considered for discharge from the ED without further investigation or mandatory period of observation.