In the city of Berlin regular combined sewer overflows (CSO) lead to acute stress of aquatic organisms in the receiving River Spree and its side channels. Of most concern are oxygen depressions, following the inflow of degradable organic matter via ~180 CSO outlets, along a river stretch of 16 km. For the assessment of the severity of these oxygen depressions, an existing impact-based approach suggested by Lammersen (1997) was combined with information on the local fish fauna. Application of this locally adapted assessment method to seven years of oxygen measurements at a CSO hotspot in the river yielded an annual average of 14 periods with suboptimal conditions for which adverse effects on the fish fauna are expected and 20 periods with critical conditions for which acute fish kills are possible. Further investigation on rain and sewer management data proved that such critical conditions only occurred as a direct result of CSO events, whereas suboptimal conditions are also possible at dry weather and may last up to 32 days (Riechel et al. 2010).