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The probability and severity of decompression sickness.

Publication ,  Journal Article
Howle, LE; Weber, PW; Hada, EA; Vann, RD; Denoble, PJ
Published in: PLoS One
2017

Decompression sickness (DCS), which is caused by inert gas bubbles in tissues, is an injury of concern for scuba divers, compressed air workers, astronauts, and aviators. Case reports for 3322 air and N2-O2 dives, resulting in 190 DCS events, were retrospectively analyzed and the outcomes were scored as (1) serious neurological, (2) cardiopulmonary, (3) mild neurological, (4) pain, (5) lymphatic or skin, and (6) constitutional or nonspecific manifestations. Following standard U.S. Navy medical definitions, the data were grouped into mild-Type I (manifestations 4-6)-and serious-Type II (manifestations 1-3). Additionally, we considered an alternative grouping of mild-Type A (manifestations 3-6)-and serious-Type B (manifestations 1 and 2). The current U.S. Navy guidance allows for a 2% probability of mild DCS and a 0.1% probability of serious DCS. We developed a hierarchical trinomial (3-state) probabilistic DCS model that simultaneously predicts the probability of mild and serious DCS given a dive exposure. Both the Type I/II and Type A/B discriminations of mild and serious DCS resulted in a highly significant (p << 0.01) improvement in trinomial model fit over the binomial (2-state) model. With the Type I/II definition, we found that the predicted probability of 'mild' DCS resulted in a longer allowable bottom time for the same 2% limit. However, for the 0.1% serious DCS limit, we found a vastly decreased allowable bottom dive time for all dive depths. If the Type A/B scoring was assigned to outcome severity, the no decompression limits (NDL) for air dives were still controlled by the acceptable serious DCS risk limit rather than the acceptable mild DCS risk limit. However, in this case, longer NDL limits were allowed than with the Type I/II scoring. The trinomial model mild and serious probabilities agree reasonably well with the current air NDL only with the Type A/B scoring and when 0.2% risk of serious DCS is allowed.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2017

Volume

12

Issue

3

Start / End Page

e0172665

Location

United States

Related Subject Headings

  • Probability
  • Models, Theoretical
  • Humans
  • General Science & Technology
  • Decompression Sickness
 

Citation

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Howle, L. E., Weber, P. W., Hada, E. A., Vann, R. D., & Denoble, P. J. (2017). The probability and severity of decompression sickness. PLoS One, 12(3), e0172665. https://doi.org/10.1371/journal.pone.0172665
Howle, Laurens E., Paul W. Weber, Ethan A. Hada, Richard D. Vann, and Petar J. Denoble. “The probability and severity of decompression sickness.PLoS One 12, no. 3 (2017): e0172665. https://doi.org/10.1371/journal.pone.0172665.
Howle LE, Weber PW, Hada EA, Vann RD, Denoble PJ. The probability and severity of decompression sickness. PLoS One. 2017;12(3):e0172665.
Howle, Laurens E., et al. “The probability and severity of decompression sickness.PLoS One, vol. 12, no. 3, 2017, p. e0172665. Pubmed, doi:10.1371/journal.pone.0172665.
Howle LE, Weber PW, Hada EA, Vann RD, Denoble PJ. The probability and severity of decompression sickness. PLoS One. 2017;12(3):e0172665.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

2017

Volume

12

Issue

3

Start / End Page

e0172665

Location

United States

Related Subject Headings

  • Probability
  • Models, Theoretical
  • Humans
  • General Science & Technology
  • Decompression Sickness