Hospital Outcomes of Spinal Injuries Associated With Aquatic Activities

Spinal injuries (SIs) that occur during aquatic activities, including swimming, surfing, or engaging with high-energy breaking waves, pose a significant public health concern. This study analyzed hospital outcomes for SIs sustained during aquatic activities, evaluating factors such as mortality, complications, length of stay (LOS), and trauma intervention.

We conducted a retrospective cohort study using data from the American College of Surgeons Trauma Quality Improvement Program registry (2017-2022). Patients included sustained SIs related to aquatic activities, identified using International Classification of Diseases, Tenth Revision codes for drowning-related mechanisms. Transport-related drownings were defined as those involving watercraft or personal watercraft. Eligible cases had documented SIs, and primary outcomes included in-hospital mortality, hospital complications, LOS, and need for surgical intervention.

In addition, 960 patients were analyzed: 87% sustained injuries from transport-related drownings, 10% from nontransport-related unintentional drownings, and 3% from intentional or undetermined drownings. Fractures were the most common injury type (85%). Nontransport-related and intentional drownings were associated with higher odds of in-hospital mortality (odds ratio: 6.74, 8.50, respectively) and prolonged LOS (incidence rate ratio: 1.19, 1.47, respectively). Intentional drownings had higher odds of in-hospital complications (odds ratio: 3.46). Alcohol consumption was linked to intentional drownings, while protective device use correlated with reduced injury severity and shorter LOS.

Optimizing fracture management, timely transfers to specialized SI centers, and promoting protective device use may improve patient outcomes. Public health initiatives discouraging alcohol consumption and enhancing aquatic safety education could reduce injury severity. Future research should address swimming ability, time to intervention, and protective device effectiveness.