Neurologic decompression illness: a gravity score.
Treatment of neurologic decompression accidents consists of various hyperbaric oxygen (HBO) protocols. To facilitate such comparisons between different protocols we developed a gravity score. A group of 96 divers was used to establish the score. On admission we first identified signs and symptoms that had possible predictive value (chi 2 test). The parameters included were repetitive dive, clinical course before HBO, objective sensory disorder, motor impairment, and urinary disturbances. Each parameter was assigned a coefficient. The sum of the coefficients for each accident, based on the most severe manifestations before decompression therapy, yielded a score for each diver. A multivariate analysis was used to evaluate the overall agreement between the model prediction and clinical observations, which was 78.7%. A second group (66 divers) was used to validate the score; this group showed a significant difference in the gravity score between the divers who had sequelae and those who did not (P = 0.0001), and between the divers who had incapacitating sequelae and those who had mild sequelae (P = 0.04). Eighty-six percent of the divers with a score above 7 developed sequelae. This index remains to be validated in a prospective multicenter study. If endorsed, valid comparisons can be made between the different therapeutic protocols.
Boussuges
A
A
Réanimation Médicale et Hyperbare, Hospital Salvator, Marseille, France.
Thirion
X
X
Blanc
P
P
Molenat
F
F
Sainty
J M
JM
D000328:Adult; D001927:Brain Diseases / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D003665:Decompression Sickness / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D004242:Diving / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012720:Severity of Illness Index