[abstract] CORRELATION OF DCI SIGNS AND SYMPTOMS WITH CLASSICAL DIAGNOSIS

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[abstract] CORRELATION OF DCI SIGNS AND SYMPTOMS WITH CLASSICAL DIAGNOSIS

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Title: [abstract] CORRELATION OF DCI SIGNS AND SYMPTOMS WITH CLASSICAL DIAGNOSIS
Author: Vann, RD; Dear, GdeL; Pieper, CF; Bute, BP; Uguccioni, DM; Thalmann, ED
Abstract: BACKGROUND: DCI data is reported to DAN on a Diving Accident Report Form (DARF). Of the 28 possible DCI signs or symptoms (SSx) listed, a maximum of 6 may be reported by the patient with a physician-assigned diagnosis of DCSI, DCSII, AGE. By definition, DCSI is incorrect if SSx other than rash, itching or limb pain are present. DCSII and AGE are incorrect if these are the only SSx present. We hypothesized that some SSx could be used to discriminate between particular diagnoses while others were associated with a misassignment of diagnoses. METHODS: For 2,822 DCI cases from 1989-94, we applied stepwise logistic regression, which tests for the association of SSx with diagnoses. We also looked at rapid ascent, out of air or onset time less than 10 min. RESULTS: There were 21.6percent of cases diagnosed as DCSI, 67.0percent as DCSII, and 11.4percent as AGE. Nine SSx (paralysis, unconsciousness, visual disturbances, numbness, difficulty walking, weakness, personality change, altered skin sensation, difficulty breathing) significantly (p less than 0.05) and strongly (odds ratio greater than 2) discriminated between DCSI and DCSII or AGE. Bladder dysfunction, convulsions, and hemoptysis were always diagnosed as DCSII or AGE but did not occur often enough to be significant or were co-linear with other SSx. Seven SSx (unconsciousness, rapid ascent or out of air, onset less than 10 min, semi-consciousness, limb pain, itching, paralysis) discriminated between AGE and DCSII. C-indices were 0.885 and 0.901 respectively, indicating excellent discrimination between groups. 44percent of DCSI, 7percent of DCSII, and 7percent of AGE diagnoses were misassigned. Numbness, weakness, or headache were associated with incorrect assignment of DCSI suggesting that in some cases clinicians may not have considered these SSx serious. CONCLUSION: SSx showed some discrimination between diagnoses. Misassignment between DCSI or DCSII was associated with numbness, weakness or headache indicating poor discrimination due to a wide range of severity. These conclusions apply to the association of SSx with classical diagnoses but do not address SSx etiology or treatment selection. (Supported by the Divers Alert Network).
Description: Undersea and Hyperbaric Medical Society, Inc. (http://www.uhms.org )
URI: http://archive.rubicon-foundation.org/408
Date: 1997

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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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