title: 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.
authors.affiliation: Department of Emergency Medicine, VU University Medical Center, Amsterdam, Netherlands. jimisin@gmail.com.
authors.forename: J W
authors.initials: JW
authors.lastname: Smithuis
authors.affiliation: Department of Emergency Medicine, Fiona Stanley Hospital, Murdoch, Perth, Western Australia.
authors.forename: E
authors.initials: E
authors.lastname: Gips
authors.affiliation: Medical Centre Hyperbaric Oxygen Therapy (MCHZ), Goes, Netherlands.
authors.forename: T P
authors.initials: TP
authors.lastname: van Rees Vellinga
authors.affiliation: Department of Emergency Medicine, Admiraal De Ruyter Hospital, Goes, Netherlands.
authors.forename: M I
authors.initials: MI
authors.lastname: Gaakeer