Background Decompression sickness (DCS) with spinal cord involvement has an unfortunately high rate of long-term sequelae. The objective of this study was to determine the association of prehospital variables on the outcome of spinal cord DCS, especially the influence of the initial clinical presentation and the time to recompression. Methods This was a retrospective study using prospectively collected data which included divers with spinal cord DCS seen at a single hyperbaric centre study from 2010 to 2018. Information regarding dive, latency of onset of symptoms, time to recompression and prehospital management, that is, use of oxygen, treatment and means of evacuation, were analysed as predictor variables. The initial clinical severity was estimated by the score of the French society of diving and hyperbaric medicine (MEDSUBHYP). The primary end point was the presence or absence of sequelae at discharge assessed by the modified score of the Japanese Orthopedic Association. Results 195 divers (48±12 years, 42 women) were included. 34% had neurological sequelae at discharge. In multivariate analysis, a MEDSUBHYP score ≥6 and a time to recompression >194 min were significantly associated with incomplete neurological recovery (OR 9.5 (95% CI 4.6 to 19.8), p<0.0001 and OR 2.1 (95% CI 1.03 to 4.5), p=0.04, respectively). Time to recompression only appeared to be significant for patients with high initial clinical severity. As time to recompression increased, the level of sequelae also increased (p=0.014). Conclusion Determining the initial clinical severity is critical in identifying patients who need to be evacuated for recompression as quickly as possible. All data relevant to the study are included in the article or uploaded as supplementary information. All de-identified participant data are available: contact Professor Blatteau (jean-eric.blatteau@intradef.gouv.fr).

中文翻译：

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院前管理对水肺潜水员脊髓减压病预后的影响

背景 不幸的是，脊髓受累的减压病 (DCS) 的长期后遗症发生率很高。本研究的目的是确定院前变量对脊髓 DCS 结果的关联，特别是初始临床表现和再加压时间的影响。方法 这是一项回顾性研究，使用前瞻性收集的数据，其中包括 2010 年至 2018 年在单一高压中心研究中观察到的脊髓 DCS 潜水员。有关潜水、症状发作潜伏期、再加压时间和院前管理的信息，即使用氧气，治疗和疏散方式，被分析为预测变量。最初的临床严重程度是通过法国潜水和高压医学协会 (MEDSUBHYP) 的评分来估计的。主要终点是出院时有无后遗症，由日本骨科协会的改良评分评估。结果 包括 195 名潜水员（48±12 岁，42 名女性）。34% 在出院时有神经系统后遗症。在多变量分析中，MEDSUBHYP 评分≥6 和再加压时间 >194 分钟与不完全神经恢复显着相关（OR 9.5（95% CI 4.6 至 19.8），p<0.0001 和 OR 2.1（95% CI 1.03 至 4.5） , p = 0.04，分别）。仅对于初始临床严重程度高的患者，再加压时间似乎很重要。随着再加压时间的增加，后遗症的水平也增加（p=0.014）。结论 确定初始临床严重程度对于确定需要尽快撤离以进行再加压的患者至关重要。所有与研究相关的数据都包含在文章中或作为补充信息上传。所有去识别的参与者数据均可用：联系 Blatteau 教授 (jean-eric.blatteau@intradef.gouv.fr)。