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Dry Drowning – Stop the Myth

March 5, 2018

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Children with a non-fatal drowning event who present to the ED with normal vital signs and normal SpO2 very rarely deteriorated.  The 3% (2/62) who had delayed complications did so within one hour of arrival. 

Why does this matter?
Parents around the globe are freaked out about “dry drowning.”  Problem is, there is no such thing.  There is fatal drowning and non-fatal drowning.  An excellent NEJM review article algorithm, based on over 41,000 drowning rescues, states that patients rescued who have cough or no cough and are otherwise healthy and have clear lungs to auscultation have 100% survival and do not need ED evaluation at all.  Of course, who carries their stethoscope to the beach?

Don’t ever, ever say “dry drowning”
This was a retrospective study of 185 patients (mean age 2.94 years) at a single center with non-fatal drowning.  They wanted to determine if children with normal age-adjusted vitals could be safely discharged immediately.  They found that 2 children with initially normal vitals and SpO2 had delayed respiratory complications.  Both of these children developed intermittent grunting within one hour of presentation.  The authors concluded that instead of the usual 6-8 hours of observation, “patients with normal age-adjusted vital signs and physical exam at presentation may not require a prolonged observation period.”

Predictors of safe discharge for pediatric drowning patients in the emergency department.  Am J Emerg Med. 2018 Jan 31. pii: S0735-6757(18)30050-0. doi: 10.1016/j.ajem.2018.01.050. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

What are your thoughts?