Future classification systems

The present trend is towards developing clearly defined case definitions for DCS, AGE and combined forms. The dilemma in developing these is that there is disparity between epidemiological and clinical objectives. The former requires specificity in favor of reliable diagnosis, the later sensitivity in favor of avoiding under-treatment. It is likely that a scoring system will ultimately be accepted which records risk-factors relevant to the exposure and clinical features consistent with a diagnosis. Then, depending on the objective the relative weighting of these factors will be adjusted respectively for greater specificity or sensitivity. The ECHM has recommended the development and acceptance of such an epidemiological classification system which will allow multi-centre, multinational, retrospective analyses derived from broad-based classifications that include the type of diving, chronological data, clinical manifestations and outcome of a two-year follow up for prognostic purposes.

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