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Abstract
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INTRODUCTION: Practitioners often routinely stabilize the cervical spine (C-spine) of submersion victims, yet immobilization can exacerbate hypothermia, interfere with airway management, lead to upper airway obstruction, and increase intracranial pressure. This case control study sought to identify risk factors for C-spine injury in submersion victims.
METHODS: We compared victims with and without C-spine injury who submerged between January 1974 and July 1996 and received medical care [emergency medical services (EMS), emergency department (ED), or hospital] in King, Pierce, or Snohomish counties in Washington State or were seen by the medical examiners of those counties.
RESULTS: Twelve (0.5%) of 2244 submersion victims had associated C-spine injuries; all were fractures. Five C-spine injuries (0.4%) occurred in 1304 submersion victims in which EMS, ED, or hospital care was provided; 7 (0.7%) occurred in 940 victims who died prior to receiving medical care (p=0.26). Three victims with C-spine injuries (25%) were ruled suicides (vs. 8% of those without C-spine injury, p=0.057). All C-spine injuries occurred following submersions in open water (vs. bathtubs or pools, p=0.01). 75% of victims with C-spine injury were <30 years old, and no C-spine injuries occurred in 871 victims less than 15 years old (p=0.005). Diving was strongly associated with C-spine injury, with an odds ratio (OR) of 20.0 [95% CI: 4.1, 97.0] compared with non-diving-related submersions. When analysis was limited to victims receiving medical care, submersions in which C-spine injury occurred were more likely in rural settings (p=0.01), were more likely to be witnessed (OR 10.3, 95% CI: 1.1, 92.2), and were associated with a lower mean ED Glascow Coma Score (GCS) than submersions without C-spine injuries (3.0 vs. 10.3, p=0.03).
CONCLUSIONS: Submersion-related C-spine injury is rare and is significantly associated in this region with specific age groups (>14 year olds), with specific pre-submersion activities, with open bodies of water, and with a low GCS on presentation. Routine C-spine immobilization, without regard to the victim's age, mechanism of injury, and physical exam, may not be warranted.
Language: en |