Diving accidents: a cohort study from the Netherlands

Abstract

Background: Diving is, besides professional reasons, an increasingly popular leisure activity. Whilst statistically compared to other sports safe, diving accidents can result in serious complications. In order to treat this specific patient category adequately, early diagnosis is important. In this study, we explore various medical aspects of diving accidents. By sharing our experiences, we intend to create awareness and enhance urgent medical care for this specific category of patients.

Methods: We conducted a retrospective cohort study using anonymized patient records from the emergency department (ED) of the Admiraal De Ruyter Hospital (ADRZ) and affiliated Medical Centre Hyperbaric Oxygen Therapy (MCHZ1) both in Goes, Netherlands. We evaluated all patients that presented to our ED as a diving accident from 1 November 2011 to 30 August 2015.

Results: In the selected period, 43 patients presented to our ED with complaints after diving; 84 % were male and 49 % older than 40 years, and they came by ambulance or referred by a general practitioner or other medical centres in the area; 70 % presented the same date as their dive, 21 % 1 to 3 days and 9 % later than 3 days after having dived. Pain was the most frequently reported symptom (44 %), followed by constitutional symptoms (42 %). Numbness or paraesthesia was reported in 33 %. Respiratory symptoms, dizziness, a change in mental status (e.g. apathy, confused or restlessness) and problems with coordination were present in 10-21 % of the cases. Symptoms that were apparent in less than 10 % of the cases were cutis marmorata, visual or auditory complaints, muscle weakness, cardiovascular symptoms or a malfunction of the anal sphincter or urinary bladder. Most of our patients exhibited more than one symptom; 70 % of all patients received hyperbaric oxygen recompression therapy.

Conclusions: The limited number of patients presenting with complaints after a diving incident, the difficulty of recognition and the (potential) huge impact if not recognized and treated adequately make us believe that every diving accident should be discussed with a centre of expertise.

Fig. 1

Distribution of presenting symptoms. Pain consisted of joint pain (56 %), abdominal pain (22 %), muscle pain (11 %) or pain somewhere else (17 %) (asterisk). Constitutional symptoms included tiredness, light-headedness, fatigue, nausea and vomiting (dagger). Pulmonary symptoms included dyspnoea, coughing and pain during respiration (Pi). Dullness, mental confusion and a loss of concentration were signs of mental symptoms (not sign). Symptoms of vision involved blurry vision and diplopia (Yen). Musculoskeletal symptoms included muscle cramps and stiffness (letter O with stroke)

Fig. 2

Incidence of amount of symptoms

Fig. 3

EKG of patient B

Fig. 4

Cutis marmorata. This picture (not belonging to patient D) shows extensive cutis marmorata, a symptom of decompression illness. Source: Dr. Neil Banham MBBS, FACEM, Dip DHM, Head of Department Hyperbaric Medicine Unit, Fiona Stanley Hospital, Australia