AEM Early Access 08: The Pediatric Submersion Score

Welcome to the eighth episode of AEM Early Access, a FOAMed podcast collaboration between the Academic Emergency Medicine Journal and Brown Emergency Medicine. Each month, we'll give you digital open access to an recent AEM Article or Article in Press, with an author interview podcast and suggested supportive educational materials for EM learners.

Find this podcast series on iTunes here.

A FOAM Collaboration: Academic Emergency Medicine Journal and Brown EM

A FOAM Collaboration: Academic Emergency Medicine Journal and Brown EM


The Pediatric Submersion Score Predicts Children at Low Risk for Injury Following Submersions Shenoi RP, Allahabadi S, Rubalcava DM, Camp EA. 

(click on title for full text; open access through December 31st, 2017)     


listen now: Interview with lead author Dr. rohit shenoi

Rohit Shenoi.jpg

Dr Rohit Shenoi, MD

Associate Professor of Pediatrics
Baylor College of Medicine
Attending Physician, Emergency Center
Texas Children's Hospital



Unintentional submersion is a leading cause of death in children under 14 in the United States. From 2005-2014, over 3,500 people died per year in the United States from unintentional drowning.  A question for the emergency physician is what cohort of 'near-drowning' pediatric patients can be safely sent home from the emergency department following a period of observation.     

A single center retrospective cross sectional study of pediatric submersion patients attempted to provide insight and potential clinical scoring system to allow for safe discharge from the ED. At a tertiary-care pediatric emergency department, records were obtained containing demographics, comorbidities, EMS records, ED timeline, bounce back in 1 week period following visit and fatality records from 2008-2015. Primary outcome was safe discharge after 8-hour observation period. Safe discharge was defined by clinical parameters including normal mental status, normal vitals, normal pulmonary exam and no need for supplemental oxygen.     

Based on the data, a 5-point scoring system was created in order to objectively characterize patients who are safe for discharge. Included in the score are the following: normal mental status, respiratory rate, absence of dyspnea, no requirement for airway support, no documented hypotension. The author reports a score of 4 or greater safe for discharge.     

Although the variables presented by the pediatric submersion score are largely intuitive, the score gives objective criteria to potentially augment disposition decision making process within the ED. A universal guideline for ED management of pediatric submersions does not exist. Recent literature has only provided patient variables that predict safe discharge. In the AEM article recently published, a retrospective cohort study of pediatric submersion found lack of need for supplemental oxygen and lack of field intervention were independent predictors of safe ED discharge. The pediatric submersion score may be most useful for the inexperienced provider or emergency departments where submersion injuries are seen infrequently. Ultimately, the pediatric submersion score provides some evidence in the literature regarding management of low risk submersion victims.

FURTHER READINg/resources:

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS).

CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016.

Predictors of emergency department discharge following pediatric drowning. Cantu RM, Pruitt CM, Samuy N, Wu CL.Am J Emerg Med. 2017 Sep 4. pii: S0735-6757(17)30722-2. doi: 10.1016/j.ajem.2017.08.057.