Demographics and functional outcome of shallow water diving spinal injuries in northern Germany - A retrospective analysis of 160 consecutive cases

Markus Stuhr; Birgitt Kowald; Arndt P Schulz; Matthias Meyer; Sven Hirschfeld; Ralf Böthig; Roland Thietje

doi:10.1016/j.injury.2023.03.002

Demographics and functional outcome of shallow water diving spinal injuries in northern Germany - A retrospective analysis of 160 consecutive cases

Injury. 2023 Mar 12:S0020-1383(23)00198-5. doi: 10.1016/j.injury.2023.03.002. Online ahead of print.

Authors

Markus Stuhr¹, Birgitt Kowald², Arndt P Schulz³, Matthias Meyer⁴, Sven Hirschfeld⁵, Ralf Böthig⁵, Roland Thietje⁵

Affiliations

¹ Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Medicine, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany. Electronic address: m.stuhr@bgk-hamburg.de.
² Zentrum für Klinische Forschung, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany.
³ Zentrum für Klinische Forschung, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany; University of Luebeck, Medical Faculty, Luebeck, Germany.
⁴ University of Luebeck, Medical Faculty, Luebeck, Germany.
⁵ Spinal Cord Injury Center, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany.

PMID: 36990902
DOI: 10.1016/j.injury.2023.03.002

Abstract

Aim: To describe demographic findings, typical injuries and functional neurological outcomes in patients with cervical trauma and tetraplegia sustained after diving into shallow water.

Patients and methods: A retrospective study was performed including all patients treated in BG Klinikum Hamburg suffering from tetraplegia after jumping into shallow water between 1st June 1980 and 31st July 2018.

Results: One hundred and sixty patients with cervical spinal injuries and tetraplegia following a dive into shallow water were evaluated. Of these, 156 patients (97.5%) were male. The mean age was 24.3 years ± 8.1 and the accidents occurred most often in inland waters (56.2%) and mostly between May and August (90.6%). In all cases there was one vertebra fractured, whereas in 48.1% of cases, two vertebrae were severed. In the majority of cases (n = 146), a surgical procedure was performed. Overall, the mean hospital stay was 202 days (±72, range: 31-403) and one patient died. On admission, 106 patients (66.2%) showed a complete lesion according to AIS A, with incomplete lesions in the remaining 54 patients (AIS B: n = 25 [15.6%], AIS C: n = 26 [16.3%], AIS D: n = 3 [1.9%]). In two thirds of the patients, the level of paralysis on admission was at the level of segments C4 (31.9%) or C5 (33.7%). Seventeen patients (10.6%) needed prehospital resuscitation. In 55 patients (34.4%), the neurological findings improved during the course of inpatient treatment and rehabilitation. Sixty-eight patients (42.5%) developed pneumonia, of which 52 patients (76.5%) were ventilated. In addition, 56.5% of patients with paralysis levels C0-C3 required ventilation, whereas only 6.3% of patients with paralysis levels C6-C7 were affected. Three patients (1.9%) were discharged from hospital with continuous ventilation. Overall, 27.4% of all AIS A patients, 56% of all AIS B patients and 46.2% of all AIS C patients improved neurologically, with 17% of all patients being able to walk.

Conclusions: The consequences of a cervical spine injury after diving into shallow water are severe and lifelong. Functionally, patients may benefit from care in a specialised centre, both in the acute phase and during rehabilitation. The more incomplete the primary paralysis, the greater the possibility of neurological recovery.

Keywords: Cervical spinal cord injury; Paraplegia; Shallow water; Tetraplegia.