title: The relative risk of decompression sickness during and after air travel following diving.
abstract: BACKGROUND
  Decompression sickness (DCS) can be provoked by post-dive flying but few data exist to quantify the risk of different post-dive, preflight surface intervals (PFSI).
  
  
  METHODS
  We conducted a case-control study using field data from the Divers Alert Network to evaluate the relative risk of DCS from flying after diving. The PFSI and the maximum depths on the last day of diving (MDLD) were analyzed from 627 recreational dive profiles. The data were divided into quartiles based on surface interval and depth. Injured divers (cases) and uninjured divers (controls) were compared using logistic regression to determine the association of DCS with time and depth while controlling for diver and dive profiles characteristics. These included PFSI, MDLD, gender, height, weight, age, and days of diving.
  
  
  RESULTS
  The means (+/-SD) for cases and controls were as follows: PFSI, 20.7 +/- 9.6 h vs. 27.1 +/- 6.7 h; MDLD, 22.5 +/- 14 meters sea water (msw) vs. 19 +/- 11.3 msw; male gender, 60% vs. 70%; weight, 75.8 +/- 18 kg vs. 77.6 +/- 16 kg; height, 173 +/- 16 cm vs. 177 +/- 9 cm; age, 36.8 +/- 10 yr vs. 42.9 +/- 11 yr; diving > or = 3 d, 58% vs. 97%. Relative to flying > 28 h after diving, the odds of DCS (95% CI) were: 1.02 (0.61, 1.7) 24-28 h; 1.84 (1.0, 3.3) 20-24 h; and 8.5 (3.85, 18.9) < 20 h. Relative to a depth of < 14.7 msw, the odds of DCS (95% CI) were: 1.2 (0.6, 1.7) 14.7-18.5 msw; 2.9 (1.65, 5.3) 18.5-26 msw; and 5.5 (2.96, 1 0.0) > 26 msw.
  
  
  CONCLUSIONS
  Odds ratios approximate relative risk in rare diseases such as DCS. This study demonstrated an increase in relative risk from flying after diving following shorter PFSIs and/or greater dive depths on the last day. The relative risk increases geometrically as the PFSI becomes smaller.
authors.affiliation: Diver's Alert Network, and Duke University Medical Center, Center for Hyperbaric Medicine and Environmental Physiology, Department of Anesthesiology, Durham, NC 27710, USA. jfreiberger@dan.duke.edu
authors.forename: J J
authors.initials: JJ
authors.lastname: Freiberger
authors.forename: P J
authors.initials: PJ
authors.lastname: Denoble
authors.forename: C F
authors.initials: CF
authors.lastname: Pieper
authors.forename: D M
authors.initials: DM
authors.lastname: Uguccioni
authors.forename: N W
authors.initials: NW
authors.lastname: Pollock
authors.forename: R D
authors.initials: RD
authors.lastname: Vann
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D016022:Case-Control Studies; D003665:Decompression Sickness / Q000209:etiology*; D004242:Diving; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012306:Risk