[abstract] CONSENSUS FACTORS USED BY EXPERTS IN THE DIAGNOSIS OF DCI

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[abstract] CONSENSUS FACTORS USED BY EXPERTS IN THE DIAGNOSIS OF DCI

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Title: [abstract] CONSENSUS FACTORS USED BY EXPERTS IN THE DIAGNOSIS OF DCI
Author: Freiberger, JJ; Lyman, SJ; Peiper, CF; Vann, RD
Abstract: BACKGROUND: The diagnosis of decompression illness (DCI) is entirely based on clinical findings and DCI experts are rare. 86percent of all chambers reporting to DAN see less than 10 cases per year. This study develops a statistically rigorous method to rank the factors important in DCI diagnosis by experts. METHODS: Eleven experts were presented with a series of 200 simulated diving injury cases (vignettes) then asked to evaluate each for the likelihood of DCS and / or AGE. A Microsoft Excel macro simulated 141 separate case factors, selected to model the information available to the DAN Emergency call system, with probabilities calculated from the DAN 2001 Report on Decompression Illness and Diving Fatalities. Specific factors included: diver characteristics (age, gender, medical history), exposure characteristics (maximum depth, times, adverse events), signs and symptoms (type, progression, severity, onset time) and treatment (delay to treatment, type, number and degree of response). All experts rated the same 200 vignettes. Multiple linear regression generated partial regression coefficients to order all factors in terms of collective importance. RESULTS: The five strongest predictors in order of importance were: DCS; 1) typical joint pain, 2) onset time of first symptom, 3) seizure (negative predictor) 4) any relief after recompression, 5) motor weakness at any time. AGE; 1) onset time of first symptom, 2) altered consciousness, 3) motor weakness at any time, 4) pain as primary symptom (negative predictor) 5) rapid ascent. Pre-existing medical conditions, age, gender, and physical characteristics were not statistically important. DISCUSSION: Rational and classical signs and symptoms, particularly the time course for symptom onset, were determined to be of greatest importance to experts, suggesting that the vignette concept will be a useful tool in the development of consensus standards for DCI similar to the Diagnostic and Statistical Manual developed by the mental health profession.
Description: Undersea and Hyperbaric Medical Society, Inc. (http://www.uhms.org )
URI: http://archive.rubicon-foundation.org/1509
Date: 2004

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  • UHMS Meeting Abstracts
    This is a collection of the published abstracts from the Undersea and Hyperbaric Medical Society (UHMS) annual meetings.

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