[abstract] REPETITIVE RECOMPRESSION IN DCI THERAPY

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[abstract] REPETITIVE RECOMPRESSION IN DCI THERAPY

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Title: [abstract] REPETITIVE RECOMPRESSION IN DCI THERAPY
Author: Vann, RD; Bute, BP; Uguccioni, DM; Smith, LR
Abstract: BACKGROUND: Repetitive recompression (Rx) contributes to DCI therapy success but raises cost. To investigate repetitive Rx effectiveness, we retrospectively analyzed 2,591 DCI patients from DAN diving accident data. Therapy effectiveness was defined as the probability that a patient would have complete relief of all symptoms (Sx) after all Rx. METHODS: Patients received 1 - 65 Rx, and 55percent were completely relieved, but none had complete relief after 15 Rx. 35percent had complete relief in 1 Rx. 17percent received only 1 Rx and did not have complete relief. The rule that repetitive Rx be given until achieving complete Sx relief or no improvement in 2 successive Rx was not followed for these patients. We estimated upper and lower bounds for the effectiveness of repetitive Rx that might have been observed had the repetitive Rx rule been followed for all patients. The lower bound assumed patients with incomplete relief in 1 or more Rx would have had complete relief with additional Rx. We used survival analysis to identify co-variate risk factors that influenced the upper bound estimate. RESULTS: At 15 Rx, the maximum lower and upper bound estimates of mean Rx effectiveness were 55 and 75percent. The gain in effectiveness became progressively smaller with each successive Rx, e.g., the gain from 7 - 15 Rx was less than 1percent. Symptoms predisposing to incomplete relief were paralysis, numbness, trunk pain, and bladder or walking problems. These are called "Serious Sx" below. The probability of complete relief decreased with the number of "Serious Sx" (p = 0.0001 - 0.0027), older age (p = 0.0001), longer Rx delay (p = 0.0003), being female (p = 0.0018), and Sx prior to the last dive (p = 0.0158) (p values indicate the statistical significance of co-variate risk factors). Rx effectiveness decreased with age until 32 years and with Rx delay until 20 hours. The table shows how various risk factors influence upper bound estimates of mean Rx effectiveness. #:Age::Rx :Delay:# "Ser:Sx":Prior:Sx Rx:16 yrs:32 yrs:1 hr:20 hrs: less than 3: greater than 3:No:Yes 1:49percent:34percent:42percent:33percent:37percent:13percent:31percent:37percent 7:88percent:70percent:77percent:69percent:74percent:32percent:74percent:66percent CONCLUSION: For DCI patients in the DAN data, we conclude: (1) up to 20percent more patients might have achieved complete relief if treated according to the repetitive Rx rule; (2) the incremental gain of each Rx decreased with the number of Rx and was less than 1percent after 7 Rx; and (3) individual patient characteristics may reduce treatment effectiveness as much as 40percent below the mean. (Supported by DAN).
Description: Undersea and Hyperbaric Medical Society, Inc. (http://www.uhms.org )
URI: http://archive.rubicon-foundation.org/490
Date: 1996

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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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