Cervical Spine Injuries among Submersion Victims

TLDR

Submersion victims are often presumed at high risk for cervical spine injury regardless of whether they sustain a traumatic injury. The study tested whether cervical spine injury is unlikely in submersion victims who do not experience high‑impact injuries. A retrospective cohort of 2,244 individuals who submerged between 1974 and 1996 in Washington State counties was analyzed for cervical spine injury. Only 0.5% (11/2,244) of submersers sustained cervical spine injuries, all of whom had high‑impact trauma (diving, vehicle crash, fall from height) and none of the 880 low‑impact cases, indicating that routine immobilization is unwarranted without traumatic injury.

Abstract

Background Submersion victims are frequently considered at high risk for cervical spine (C-spine) injury regardless of whether they sustain a traumatic injury. We hypothesized that C-spine injury is unlikely in submersion victims who do not sustain high-impact injuries. Methods The study was a cohort study of all people who submerged between January 1974 and July 1996 and received medical care or were seen by the medical examiner in King, Pierce, and Snohomish counties in Washington State. Results Eleven (0.5%) of 2,244 submersion victims had C-spine injuries. All 11 had submerged in open bodies of water; had clinical signs of serious injury; and had a history of diving, motorized vehicle crash, or fall from height. No C-spine injuries occurred in 880 low-impact submersions. Conclusion Submersion victims are at risk for C-spine injury only if they have also sustained a traumatic injury. Routine C-spine immobilization does not appear to be warranted solely on the basis of a history of submersion.