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Table 1 Incidence of SIPE

From: Occurrence, Risk Factors, Prognosis and Prevention of Swimming-Induced Pulmonary Oedema: a Systematic Review

References Study design Subjects Sample size and description Type of exposure Case definition Case ascertainment method Incidence reported (n = SIPE cases) Critical evaluation (see Additional file 4 for more detail)
Smith et al. [16] Prospective incidence study Triathletes 68,557 competitors in 11 triathlon races in the UK between 2011 and 2016, distances of 400 m, 750 m and 1500 m Not reported Absence of water aspiration, acute onset of dyspnoea, cough and/or frothy sputum, with evidence of pulmonary oedema on physical examination Medical records of competitors presenting to medical team 0.01% (n = 5) of triathlons raced Conference abstract so limited detail. Only included competitors that sought medical assistance. No information on demographics. Unclear if any cases were recurrences in same individual
Braman Eriksson et al. [15] Prospective incidence study Outdoor swimmers (elite and amateur) 13,878 swimmers (6317 males, 7561 females) aged 12–70 competing in Swedish river races over 3 days in July 2016, distances of 1–3 km Moderately cold freshwater (17 °C), unknown number of swimmers wore wetsuits No standard definition. Examining physicians identified cases without a formal case definition. Clinical examination of competitors presenting to medical team Approx. 0.5% (n = 69) of races swum Patient symptoms and clinical findings were not recorded. No information on competitors that did not seek medical attention
Adir et al. [12] Prospective incidence study Military trainees (Israeli Navy) Unknown number of males aged 18–19 in swimming trials of 2.4–3.6 km distance (average of 30–45 min duration) in 1998–2001 Open sea of varying temperatures (19.6 °C ± 3.2), no wetsuits, supine semi-reclining position with fins Severe shortness of breath and coughing during or after swimming in the absence of sea aspiration, and evidence of PE found on medical examination Interview and clinical examination of swimmers presenting to medical team 1.8% (n = 70) of swimming trials performed Unknown total number of swimmers and time trials. Unclear number of new cases versus recurrences
Shupak et al. [13] Prospective incidence study Military trainees (Israeli Navy) 35 males aged 18–19 performing 5 swimming trials (2.4–3.6 km) over 2 months (mid-Jan to mid-Mar). Trials were ≥ 1 week apart Moderately cold open sea, (16–18 °C), diving jackets, supine position with fins When, in the absence of prior seawater aspiration, the swimmer reported shortness of breath accompanied by coughing Post-swim questionnaire completed by all trainees 16.6% of 175 swimming trials: 8 severe cases (4.6%), 21 mild cases (12%) 60% of swimmers (n = 21) had 29 episodes of SIPE Sample size small. Study only lasted 2 months
Weiler-Ravell et al. [14] Prospective incidence study Military trainees (Israeli Navy) 30 males aged 18–19 performing a single 2.4 km swimming trial Warm open sea (23 °C), no wetsuit, supine with fins, over- hydration (trainees drank approx. 5 l of water prior to swimming) Dyspnoea and haemoptysis Clinical examination of trainees presenting to medical team 26.7% (n = 8) of swimmers in one trial Only one swimming trial. No clear case definition
  1. IPE immersion pulmonary oedema, PE pulmonary oedema