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

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 sev-ered. 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 ven-tilation, 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 neurolog-ical recovery.(c) 2023 Elsevier Ltd. All rights reserved.

Automated summary

This retrospective study investigated demographic findings, typical injuries, and neurological outcomes in patients with cervical trauma and tetraplegia caused by diving into shallow water. A total of 160 patients were evaluated, with the majority being young males who sustained injuries in inland waters during the summer months. Surgical procedures were performed in most cases, and the average hospital stay was 202 days. Neurological improvement was observed in a significant number of patients, but the consequences of the injuries were severe and lifelong. Specialized care in both the acute phase and rehabilitation can benefit these patients.