Abstract
Study design:
This is a retrospective study.
Objectives:
The aim of this study is to examine the main features and short-term neurological outcomes associated with injuries to the spine due to diving into water in a Latin American country.
Setting:
Salvador, Brazil.
Patient sample:
A total of 1324 subjects were admitted with spinal trauma between 1991 and 2006 (inclusive). Subjects aged between 14 and 65 years who sustained diving injuries corresponded to 10.6% (N=140) of the cases.
Outcome measures:
Neurological status was determined by the Frankel Functional Scale (FFS) on admission and discharge. The FFS was secondarily converted to the American Spinal Injury Association impairment scale.
Methods:
This study is a patient record database review that examines demographic and injury-related characteristics, details of hospital treatment and neurological status at the time of discharge.
Results:
Males (N=129) outnumbered females (N=11) in a proportion of 12:1 (mean age: 28.62 years). The cervical spine region was the most affected area (92.1%) and 45% of the cases presented with tetraplegia. On admission, neurologically complete lesions accounted for 32.1% of the overall cases and 45.7% were neurologically intact. The mean length of stay (7.7 weeks) did not differ with regard to treatment option (P=0.83). During hospitalization, patients with incomplete neurological impairment had shorter lengths of stay and showed more neurological improvement than those with complete lesions (P=0.26 and 64.5 versus 2.2%, P<0.0001).
Conclusion:
Diving spine injuries have a high tetraplegia rate. Neurological recovery and shorter length of stay are associated with incomplete lesions.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Blitvich JD, McElroy GK, Blanksby BA, Douglas GA . Characteristics of ‘low risk’ and ‘high risk’ dives by young adults: risk reduction in spinal cord injury. Spinal Cord 1999; 37: 553–559.
Green BA, Gabrielsen MA, Hall WJ, O’Heir J . Analysis of swimming pool accidents resulting in spinal cord injury. Paraplegia 1980; 18: 94–100.
DeVivo MJ, Sekar P . Prevention of spinal cord injuries that occur in swimming pools. Spinal Cord 1997; 35: 509–515.
Bailes JE, Herman JM, Quigley MR, Cerullo LJ, Meyer Jr PR . Diving injuries to the cervical spine. Surg Neurol 1990; 34: 155–158.
Maynard Jr FM, Bracken MB, Creasey G, Ditunno Jr JF, Donovan WH, Ducker TB et al. International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord 1997; 35: 266–274.
Oliveira LAP . In: Bivar W (ed). Síntese de indicadores sociais: uma análise das condições de vida da população brasileira. Instituto Brasileiro de Geografia e Estatística: Rio de Janeiro, 2008, pp 31–37.
Dean AG, Dean JA, Coulombier D, Brendel KA, Smith DC, Burton AH et al. Epi Info, Version 6.04a, a word processing, database, and statistics program for public health on IBM-compatible microcomputers. Centers for Disease Control and Prevention: Atlanta, GA, USA, 1996.
Shields Jr CL, Fox JM, Stauffer ES . Cervical cord injuries in sports. Phys Sports Med 1978; 6: 71–76.
Aito S, D’Andrea M, Werhagen L . Spinal cord injuries due to diving accidents. Spinal Cord 2005; 43: 109–116.
Kluger YK, Jarosz D, Paul DB, Townsend RN, Diamond DL . Diving injuries: a preventable catastrophe. J Trauma 1994; 36: 349–351.
Schmitt H, Gerner HJ . Paralysis from sport and diving accidents. Clin J Sport 2001; 11: 17–22.
Tator CH, Edmonds VE, New ML . Diving: a frequent an potentially preventable cause of spinal cord injury. Can Med Assoc J 1981; 124: 1323–1324.
Korres DS, Benetos IS, Themistocleous GS, Mavrogenis AF, Nikolakakos L, Liantis PT . Diving injuries of the cervical spine in amateur divers. Spine J 2006; 6: 44–49.
Albrand OW, Corkhill G . Broken neck from diving accidents: a summer epidemic in young men. Am J Sports Med 1976; 4: 107–110.
Kiwerski JE . Cervical spine injuries caused by diving into water. Paraplegia 1980; 18: 101–109.
American College of Surgeons In: Advanced Trauma Life Support Student Manual. 6th edn. American College of Surgeons: Brazil, 1999, pp 226.
Chang SK, Tominaga GT, Wong JH, Weldon EJ, Kaan KT . Risk factors for water sports-related cervical spine injuries. J Trauma 2006; 60: 1041–1046.
Tooth L, McKenna K, Geraghty T . Rehabilitation outcomes in traumatic spinal cord injury in Australia: functional status, length of stay and discharge setting. Spinal Cord 2003; 41: 220–230.
Barrett TW, Mower WR, Zucker MI, Hoffman JR . Injuries missed by limited computed tomographic imaging of patients with cervical spine injuries. Ann Emerg Med 2006; 47: 129–133.
Nolasco VP, Pável RC, Moura R . In: DaCosta L (ed). Atlas do Esporte no Brasil. CONFEF: Rio de Janeiro, 2006, pp 8232–8235.
Acknowledgements
We express appreciation to all members of the Liga do Trauma—Escola Bahiana de Medicina e Saúde Pública, Dr Juarez Dias, physicians, hospital and rehabilitation personnel of the Hospital Geral do Estado who assisted in the data collection, entry or by providing technical advice. We especially thank Cassandra Delp for detailed help during preparation of the paper.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Amorim, E., Vetter, H., Mascarenhas, L. et al. Spine trauma due to diving: main features and short-term neurological outcome. Spinal Cord 49, 206–210 (2011). https://doi.org/10.1038/sc.2010.79
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2010.79
Keywords
This article is cited by
-
Rehabilitation outcome in people with spinal cord injuries resulting from diving in South Korea
Spinal Cord Series and Cases (2022)
-
Prevention of diving-induced spinal cord injuries—preliminary results of the first Romanian mass media prophylactic educational intervention
Spinal Cord Series and Cases (2017)


