title: Cervical spinal cord injury associated with near-drowning does not increase pneumonia risk or mortality.
abstract: Body surfing accidents (BSA) can cause cervical spinal cord injuries (CSCIs) that are associated with near-drowning (ND). The submersion injury from a ND can result in aspiration and predispose to pulmonary complications. We predicted a worse outcome (particularly the development of pneumonia) in patients with CSCIs associated with ND. A retrospective review was performed of patients who were treated at Eastern Virginia Medical School for a CSCI resulting from a blunt mechanism. Data collected included basic demographic data, data regarding injury and in-hospital outcomes, and discharge data, including discharge disposition. Statistics were performed using χ(2) and Student t test. In 2003 to 2008, 141 patients were treated for CSCIs with inclusion criteria. Thirty patients (21%) had an associated ND (BSA) and 111 patients (79%) did not (BLT). The cohorts were similar in mean age (BSA, 45 years; BLT, 50 years; P = 0.16) and male gender distribution (BSA, 93%; BLT, 79%; P = 0.13). The cohorts were similar in injury severity using Injury Severity Score (BSA, 22; BLT, 24; P = 0.65). The cohorts were similar in rates of developing pneumonia (BSA, 3%; BLT, 12%; P = 0.31). The rate of infection was significantly higher in the cohort without an associated near-drowning (BSA, 10%; BLT, 32%; P = 0.033). The mean intensive care unit stay (BSA, 3.5 days; BLT, 11.3 days; P = 0.057) and the rate of mortality were similar (BSA, 10%; BLT, 10% P = 0.99). Those patients with an associated ND had a shorter hospital stay (BSA, 5.7 days; BLT, 22.2 days; P = 0.007) and a better chance of being discharged home (BSA, 57%; BLT, 27%; P = 0.004). CSCIs after a BSA do better than their counterparts without an associated ND. CSCIs associated with ND appear to be isolated injuries with minimal pulmonary involvement despite submersion injuries.
authors.affiliation: Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia 23507, USA. butlert@evms.edu
authors.forename: Thomas
authors.initials: T
authors.lastname: Butler
authors.forename: Susanna
authors.initials: S
authors.lastname: Shin
authors.forename: Jay
authors.initials: J
authors.lastname: Collins
authors.forename: Rebecca C
authors.initials: RC
authors.lastname: Britt
authors.forename: Scott F
authors.initials: SF
authors.lastname: Reed
authors.forename: Leonard J
authors.initials: LJ
authors.lastname: Weireter
authors.forename: L D
authors.initials: LD
authors.lastname: Britt
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015701:Near Drowning / Q000150:complications*; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012306:Risk; D013119:Spinal Cord Injuries / Q000150:complications*; D013550:Swimming / Q000293:injuries; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications*