L Noonan1, R Howrey, C M Ginsburg. 1. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235, USA.
Abstract
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.
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.