Department of Emergency Medicine, Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia.
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
Emerg Med Australas. 2023 Feb;35(1):18-24. doi: 10.1111/1742-6723.14036. Epub 2022 Jul 25.
Wave forced impacts are known to result in cervical spine injuries (CSI) and approximately 20% of drownings in Australia occur at the beach. The most common mechanism of injury in studies examining the frequency of CSI in drowning patients is shallow water diving. The aim of the present study was to determine what proportion of CSIs occurring in bodies of water experienced a concomitant drowning injury in a location where wave forced impacts are likely to be an additional risk factor.
Electronic medical records at the Sunshine Coast Hospital and Health Service EDs, Queensland Ambulance Service case records and Surf Life Saving Queensland data between 1 January 2015 and 21 April 2021 were manually linked. Outcomes recorded included victim demographics, scene information, hospital course and patient disposition.
Ninety-one of 574 (15.9%) CSIs occurred in a body of water with risk of drowning. However, only 4 (4.3%) had a simultaneous drowning injury, representing 0.8% (4/483) of drowning presentations. Ten (10.9%) patients reported loss of consciousness, including the four with drowning. The principal mechanism of CSI was a wave forced impact (71/91, 78%). Most injuries occurred at the beach (79/91, 86.8%). Delayed presentation was common (28/91, 31%). A history of axial loading was 100% sensitive when indicating imaging.
The combination of CSI and drowning is uncommon. Cervical spine precautions are only required in drowning patients with signs or a history, or at high risk of, axial loading of the spine. This paper supports the move away from routine cervical spine precautions even in a high-risk population.
众所周知，波浪强迫冲击会导致颈椎损伤（CSI），大约 20%的澳大利亚溺水事件发生在海滩。在研究溺水患者 CSI 频率的研究中，最常见的损伤机制是浅水潜水。本研究旨在确定在可能存在波浪强迫冲击这一额外危险因素的水域中发生的 CSI 中有多大比例同时伴有溺水损伤。
手动链接昆士兰州阳光海岸医院和卫生服务急诊部、昆士兰救护车服务病例记录和冲浪救生昆士兰 2015 年 1 月 1 日至 2021 年 4 月 21 日的数据。记录的结果包括受害者人口统计学、现场信息、医院过程和患者处置。
574 例 CSI 中有 91 例发生在有溺水风险的水体中。然而，只有 4 例（4.3%）同时有溺水损伤，占溺水病例的 0.8%（4/483）。10 例（10.9%）患者报告失去意识，其中包括 4 例溺水患者。CSI 的主要机制是波浪强迫冲击（71/91，78%）。大多数损伤发生在海滩（79/91，86.8%）。延迟就诊很常见（28/91，31%）。轴向负荷的病史 100%敏感，可指示影像学检查。
CSI 和溺水的组合并不常见。只有在有迹象、病史或有脊柱轴向负荷高风险的溺水患者中才需要进行颈椎保护。本文支持即使在高危人群中也应避免常规进行颈椎保护。
