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Influence of prehospital management on the outcome of spinal cord decompression sickness in scuba divers
  1. Sophie Andre1,2,
  2. Henri Lehot1,
  3. Jean Morin1,
  4. Pierre Louge1,3,
  5. Sébastien de Maistre1,
  6. Romain Roffi1,
  7. Arnaud Druelle1,
  8. Emmanuel Gempp1,
  9. Nicolas Vallée4,
  10. Muriel Vergne5,
  11. Jean-Eric Blatteau1
  1. 1Hyperbaric and Diving Medicine, HIA Sainte Anne, Toulon Armees, France
  2. 2SAMU 83 Var France, Toulon, France
  3. 3Hyperbaric Medicine, HUG, Geneve, Switzerland
  4. 4ERRSO, IRBA, Bretigny-sur-Orge, France
  5. 5SAMU de coordination médicale maritime, SAMU 83 Var France, Toulon, France
  1. Correspondence to Professor Jean-Eric Blatteau, hyperbaric and diving medicine, HIA Sainte Anne, Toulon Armees, France; blatteauje{at}gmail.com

Abstract

Background Decompression sickness (DCS) with spinal cord involvement has an unfortunately high rate of long-term sequelae. The objective of this study was to determine the association of prehospital variables on the outcome of spinal cord DCS, especially the influence of the initial clinical presentation and the time to recompression.

Methods This was a retrospective study using prospectively collected data which included divers with spinal cord DCS seen at a single hyperbaric centre study from 2010 to 2018. Information regarding dive, latency of onset of symptoms, time to recompression and prehospital management, that is, use of oxygen, treatment and means of evacuation, were analysed as predictor variables. The initial clinical severity was estimated by the score of the French society of diving and hyperbaric medicine (MEDSUBHYP). The primary end point was the presence or absence of sequelae at discharge assessed by the modified score of the Japanese Orthopedic Association.

Results 195 divers (48±12 years, 42 women) were included. 34% had neurological sequelae at discharge. In multivariate analysis, a MEDSUBHYP score ≥6 and a time to recompression >194 min were significantly associated with incomplete neurological recovery (OR 9.5 (95% CI 4.6 to 19.8), p<0.0001 and OR 2.1 (95% CI 1.03 to 4.5), p=0.04, respectively). Time to recompression only appeared to be significant for patients with high initial clinical severity. As time to recompression increased, the level of sequelae also increased (p=0.014).

Conclusion Determining the initial clinical severity is critical in identifying patients who need to be evacuated for recompression as quickly as possible.

  • hyperbaric medicine
  • critical care transport
  • helicopter retrieval
  • neurology
  • spinal

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All de-identified participant data are available: contact Professor Blatteau (jean-eric.blatteau@intradef.gouv.fr).

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. All de-identified participant data are available: contact Professor Blatteau (jean-eric.blatteau@intradef.gouv.fr).

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Footnotes

  • Handling editor David Metcalfe

  • Contributors J-EB and SA conceived and designed the research. J-EB and SA performed the analysis. J-EB, SA, HL, JM, PL, EG, RR, AD, NV and MV analysed the data and interpreted the results, J-EB, SA and NV prepared the tables and figures. J-EB and SA edited and revised the manuscript. All approved the final version of the manuscript. J-EB is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.