Tom, Andy

Introduction: Scuba diving is a popular sport that carries risks unique to the underwater environment. Paediatric emergency department presentations for scuba diving injuries are incompletely characterised, particularly in comparison with adults. Methods: We retrospectively analysed scuba-related injuries recorded in the National Electronic Injury Surveillance System (NEISS) from 2005–2024. We estimated national paediatric emergency department presentations using NEISS weights and compared injury categories and hospitalisation rates between paediatric and adult patients. Results: We identified 68 paediatric cases, corresponding to an estimated 122 paediatric scuba-related emergency department presentations annually. Trauma was the most common injury category (41.2%), followed by otitis (17.6%) and ear, sinus, ocular, or dental barotrauma (16.2%). Hospitalisation was most common among patients with possible decompression sickness or arterial gas embolism (DCS/AGE) (42.9%) and drowning/aspiration (25.0%). Compared with adults, paediatric patients were less often hospitalised (10.3% vs 21.4%, P = 0.038), more likely to present with traumatic injuries (41.2% vs 26.1%, P = 0.010), and less likely to present with possible DCS/AGE (10.3% vs 25.0%, P = 0.006). Conclusions: Among patients presenting to United States emergency departments with scuba-related injuries, paediatric patients most commonly had trauma, otitis, or ear, sinus, ocular, or dental barotrauma. Paediatric divers were also less likely than adults to experience DCS/AGE injuries and were less likely than adults to require hospitalisation. Our data describes emergency department presentation patterns rather than overall injury risk among paediatric scuba divers.

Background: Pyrocarbon metacarpophalangeal (MCP) arthroplasty is associated with high rates of recurrent deformity and reoperation in patients with rheumatoid arthritis (RA). We sought to determine the impact of preoperative hand grip strength (HGS) on implant survivorship in these patients. Methods: We included primary pyrocarbon MCP arthroplasties in patients with RA at our single institution from 2000 to 2022. Cox proportional hazard models with restricted cubic splines were used to model the continuous relationship between HGS and hazard for revision, all-cause reoperation, and development of any complication, accounting for multiple joints per patient and adjusting for sex. Kaplan-Meier estimates were used to report survivorship at 2, 5, and 10 years. Results: We included 75 joints in 27 patients with an average preoperative HGS of 8.6 kg (11.1 years of follow-up). There were 16 (21%) total revisions, most commonly for recurrent deformity, along with 8 nonrevision reoperations, most commonly for tendon/ligamentous repair. There was a significant, J-shaped relationship between HGS and hazard for revision ( P = .001) and all-cause reoperation ( P < .001). Patients with HGS below 5.5 and 5.3 kg had an increased risk for revision (hazard ratio [HR]: 13.5) and all-cause reoperation (HR: 9.8) compared with patients with sufficiently high HGS. The 10-year revision survival was 93% in patients with HGS >5.5 kg and 63% in patients ≤5.5 kg. Hand grip strength did not significantly affect hazard for developing a first complication. Conclusion: Very low preoperative HGS is associated with worsened implant survivorship following pyrocarbon MCP arthroplasty in patients with RA.