Drowning is among the top ten causes of death in children in all regions of the world. Literature is scarce on hospital resource utilization in pediatric drowning. We aimed to identify predictors of discharge home in children presenting to the emergency department (ED) after accidental drowning.

In this retrospective cohort study, we studied children 0-18 years old presenting to the ED of an urban, free-standing tertiary care children's hospital with submersion injury from 1/1/10 to 12/31/14. Subjects were identified via International Classification of Diseases, Ninth Revision, codes, excluding those indicating intentional injury. Primary outcome was ED disposition. Covariates included standard demographics, witnessed event, field intervention (e.g. cardiopulmonary resuscitation), triage vital signs, radiography, and blood gas analysis. Routine statistical analysis and multivariable logistic regression with adjusted odds ratios (aOR) were performed with SAS 9.4.

Ninety-one ED visits were screened with one excluded due to miscoding. The majority were male (59%), non-Hispanic white (72%), and urban (90%). Patients tended to be of younger age (48% age 1-5 years). Fifty-seven children (63%) were admitted, 23 required ICU level care (26%), and one died. In multivariable analysis, ED discharge was significantly more likely with normal oxygen saturations in triage (aOR 6.80, p=0.04) and no field intervention (aOR 5.10; p=0.02).

Children with accidental submersion injury were significantly more likely to be discharged from the ED if they had normal oxygen saturation and no immediate field intervention reported. Future research includes linking these factors to patient outcomes and standardizing clinical approach.