title: Prognostic factors of spinal cord decompression sickness in recreational diving: retrospective and multicentric analysis of 279 cases.
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.
authors: Institut de Recherche Biomédicale des Armées, Antenne Toulon, UMR - MD2, P2COE Université de la Méditerranée, BP 20548, 83041, Toulon Cedex 9, France. je.blatteau@infonie.fr
authors: Jean-Eric
authors: JE
authors: Blatteau
authors: E
authors: E
authors: Gempp
authors: O
authors: O
authors: Simon
authors: M
authors: M
authors: Coulange
authors: B
authors: B
authors: Delafosse
authors: V
authors: V
authors: Souday
authors: G
authors: G
authors: Cochard
authors: J
authors: J
authors: Arvieux
authors: A
authors: A
authors: Henckes
authors: P
authors: P
authors: Lafere
authors: P
authors: P
authors: Germonpre
authors: J-M
authors: JM
authors: Lapoussiere
authors: M
authors: M
authors: Hugon
authors: P
authors: P
authors: Constantin
authors: A
authors: A
authors: Barthelemy
mesh_terms: D000328:Adult; D001530:Belgium; D002985:Clinical Protocols; D003665:Decompression Sickness / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D004242:Diving / Q000293:injuries*; D005260:Female; D005602:France; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*