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Prognostic Factors of Spinal Cord Decompression Sickness in Recreational Diving: Retrospective and Multicentric Analysis of 279 Cases

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Abstract

Background

This study aims to determine the potential risk factors associated with the development of severe diving-related spinal cord decompression sickness (DCS).

Methods

Two hundred and seventy nine injured recreational divers (42 ± 12 years; 53 women) presenting symptoms of spinal cord DCS were retrospectively included from seven hyperbaric centers in France and Belgium. Diving information, symptom latency after surfacing, time interval between symptom onset and hyperbaric treatment were studied. The initial severity of spinal cord DCS was rated with the Boussuges severity score, and the presence of sequelae was evaluated at 1 month. Initial recompression treatment at 2.8 ATA with 100% oxygen breathing or deeper recompression up to 4 or 6 ATA with nitrogen or helium–oxygen breathing mixture were also recorded.

Results

Twenty six percent of DCS had incomplete resolution after 1 month. Multivariate analysis revealed several independent factors associated with a bad recovery: age ≥42 [OR 1.04 (1–1.07)], depth ≥39 m [OR 1.04 (1–1.07)], bladder dysfunction [OR 3.8 (1.3–11.15)], persistence or worsening of clinical symptoms before recompression [OR 2.07 (1.23–3.48)], and a Boussuges severity score >7 [OR 1.16 (1.03–1.31)]. However, the time to recompression and the choice of initial hyperbaric procedure did not significantly influence recovery after statistical adjustment.

Conclusions

Clinical symptoms of spinal cord DCS and their initial course before admission to the hyperbaric center should be considered as major prognostic factors in recovery. A new severity score is proposed to optimize the initial clinical evaluation for spinal cord DCS.

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Acknowledgments

We would like to thank Pascal Constantin and Christel Blassin for their pertinent linguistic reviewing.

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Authors and Affiliations

  1. Institut de Recherche Biomédicale des Armées, Antenne Toulon, UMR – MD2, P2COE Université de la Méditerranée, BP 20548, 83041, Toulon Cedex 9, France

    Jean-Eric Blatteau

  2. HIA Sainte-Anne, 83041, Toulon Cedex 9, France

    E. Gempp, M. Hugon & P. Constantin

  3. Hôpital Pasteur, 06002, Nice Cedex 1, France

    O. Simon & J.-M. Lapoussiere

  4. Hôpital Sainte-Marguerite, 13009, Marseille, France

    M. Coulange & A. Barthelemy

  5. Hôpital Edouard Herriot, 69000, Lyon, France

    B. Delafosse

  6. CHU, 49033, Angers Cedex 1, France

    V. Souday

  7. Hôpital la Cavale Blanche, 29609, Brest, France

    G. Cochard, J. Arvieux & A. Henckes

  8. Hôpital Militaire Reine Astrid, 1120, Bruxelles, Belgium

    P. Lafere & P. Germonpre

Authors
  1. Jean-Eric Blatteau
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  2. E. Gempp
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  3. O. Simon
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  4. M. Coulange
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  7. G. Cochard
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  8. J. Arvieux
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  10. P. Lafere
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  11. P. Germonpre
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  12. J.-M. Lapoussiere
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  13. M. Hugon
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  14. P. Constantin
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  15. A. Barthelemy
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Correspondence to Jean-Eric Blatteau.

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Blatteau, JE., Gempp, E., Simon, O. et al. Prognostic Factors of Spinal Cord Decompression Sickness in Recreational Diving: Retrospective and Multicentric Analysis of 279 Cases. Neurocrit Care 15, 120–127 (2011). https://doi.org/10.1007/s12028-010-9370-1

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  • DOI: https://doi.org/10.1007/s12028-010-9370-1

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