Consensus factors used by experts in the diagnosis of decompression illness.

INTRODUCTION: The diagnosis of decompression illness (DCI) is entirely based on clinical findings and DCI experts are rare. Of all the chambers reporting to Diver's Alert Network (DAN), 86% see less than 10 cases per year. Simulated diving injury cases (vignettes) were used to identify diagnostic factors important to 11 international experts attending the 2003 Undersea and Hyperbaric Medical Society symposium on DCI diagnosis. METHODS: There were 200 vignettes evaluated for the probability of DCS and/or arterial gas embolism (AGE). Vignettes were constructed from 141 factors that modeled information from DAN's emergency call system. Factor probability mirrored DAN's 2001 Report on Decompression Illness and Diving Fatalities. Factors included: diver characteristics, exposure characteristics, signs, symptoms, treatment, and response. Multiple linear regression with stepwise elimination identified and ordered the significant factors in terms of their importance to the experts. Results were confirmed with logistic regression. RESULTS: For DCS, the top five factors in order of importance were: 1) a neurological symptom as the primary presenting symptom; 2) onset time of symptoms; 3) joint pain as a presenting symptom; 4) any relief after recompression treatment; and 5) the maximum depth of the last dive. For AGE, the top five factors were: 1) onset time of symptoms; 2) altered consciousness; 3) any neurological symptoms as a presenting symptom; 4) motor weakness; and 5) seizure as the primary presenting symptom. Age, gender, or physical characteristics were not statistically important. CONCLUSIONS: The vignette concept may be useful in the development of consensus standards for DCI diagnosis.

Duke Scholars

Author Carl F. Pieper Biostatistics & Bioinformatics, Division of Biostatistics

Author John Jacob Freiberger Anesthesiology