European Journal of Pediatrics

, Volume 178, Issue 9, pp 1379–1384 | Cite as

Predictors for hospital admission of asymptomatic to moderately symptomatic children after drowning

  • Neta CohenEmail author
  • Tali Capua
  • Sharon Lahat
  • Miguel Glatstein
  • Efraim Sadot
  • Ayelet Rimon
Original Article


Drowning is a leading cause of injury-related death worldwide, but there are limited data on the management and disposition of asymptomatic and mildly symptomatic adults and children following a drowning event. Some authors have recommended admission for all drowning victims due to the possibility of respiratory and clinical deterioration in a seemingly well patient. In order to identify predictors for admission and to establish a unified approach for management, we retrospectively collected all children ≤ 16 years old presented following a drowning event to the pediatric ED over a period of 12 years. The children were divided into two groups, those who were discharged home from the ED and those who were admitted. Seventy-one surviving and non-intubated children were asymptomatic to moderately symptomatic, and they comprised the study group. Crepitations on lung auscultation, oxygen desaturation, and respiratory distress were significantly higher in the admitted group (n = 26) compared with the discharged group (n = 45) (P < 0.05). Respiratory distress and lung crepitations were independent predictors for admission. Eventually, 30% of the hospitalized patients required oxygen therapy, but there were no cases that deteriorated and required invasive ventilation. No readmissions occurred in the group of children who were discharged from the ED.

Conclusion: Children who after six hours show no respiratory distress and have normal oxygen saturation and normal auscultation can be safely discharged home. Respiratory distress and lung crepitations should both warrant the physician to consider admission of asymptomatic to moderately symptomatic children following a drowning event. An algorithm to assist patient management is proposed.

What is Known:

There are few data in the literature regarding the management and disposition of asymptomatic to moderately symptomatic children after drowning.

What is New:

We found that respiratory distress and lung crepitations are independent predictors for admission. An algorithm to assist patient management is proposed.


Children Non-fatal drowning event Respiratory distress Lung crepitations Disposition 


Authors’ contributions

Neta Cohen contributed significantly to the planning of the study and the study design, collected data, performed statistical analysis, and did major manuscript preparation. Tali Capua performed statistical analysis and collected data. Sharon Lahat contributed her manuscript expertise. Miguel Glatstein contributed his manuscript expertise. Efraim Sadot contributed to the study design and manuscript editing and contributed his manuscript expertise. Ayelet Rimon contributed significantly to the study design and manuscript editing and contributed her manuscript expertise.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pediatric Emergency Medicine, Sackler Faculty of Medicine, Dana-Dwek Children’s HospitalTel Aviv Sourasky Medical CenterTel AvivIsrael
  2. 2.Department of Pediatrics, Sackler Faculty of MedicineTel-Aviv UniversityTel AvivIsrael
  3. 3.Pediatric Intensive Care Unit, Dana-Dwek Children’s HospitalTel Aviv Medical CenterTel AvivIsrael

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