Ten-year Spanish cohort of diving-related injuries in a non-hyperbaric tertiary hospital on the Spanish Mediterranean coast

Introduction: Global evidence on the epidemiology of prevalent diving-related injuries (DRI) different from decompression sickness (DCS) and other fatalities is lacking. This study aimed to perform a comprehensive review of DRIs in the year-period between 2010-2020 in a non-hyperbaric tertiary hospital in the Spanish Mediterranean coast, in addition to identifying patient risk factors for severe middle ear barotrauma. Methods: The study was conducted via a retrospective review of medical records during a 10-year period (2010- 2020) at the University and Polytechnic Hospital La Fe (UPHLF) of Valencia. We performed a case-control study recruiting controls through an online survey to identify independent predictors for severe middle ear barotrauma. Results: A total of 68 patients with DRI attended the emergency department of our tertiary referral hospital. Barotrauma accounted for more than 80% of DRI, followed by unrecognized DCS and animal-related injuries. Most patients required neither hospital admission nor surgery; appropriate treatment could be carried out largely on an outpatient basis. The presence of subsequent sequelae was minimal. Previous presence of significant ear, nose and throat (ENT) comorbidities (OR 3.05 – CI 95% 1.11 – 8.35), and older age (OR of younger age 0.94 – CI 95% 0.91 – 0.98) were identified as independent risk factors for severe middle ear barotrauma, with an acceptable discrimination capacity (AUC 0.793, 95% CI 0.71 – 0.87). Conclusions: The incidence of DRI may be higher than previously thought, and the need to know their epidemiology, their associated morbidity, and the deficiencies of the diving management system is becoming steadily important in order to develop prevention, diagnostic and therapeutic protocols in non-hyperbaric hospitals of these regions.