The Classification Systems

To date, three enduring systems have appeared for the classification of

• the traditional or Golding Classification 26

• the descriptive or Francis / Smith Classification 27-29

• the ICD-10 Classification

Each of these classification systems addresses different objectives and accordingly has inherent strengths and weaknesses.

3.2.1 The Traditional / Golding Classification

The Golding classification, developed during the building of the Dartford Tunnel, was based on the assumption that DI was bivariate 26: It was either inert gas (decompression sickness or DCS) or embolic (arterial gas embolism or AGE) related. DCS was either mild (Type I) or severe (Type II) and each category had specific treatment recommendations. Then, in 1970 a combined form of DCS and AGE was described. It was called "Type III decompression sickness" in an effort to contain it within the existing classification system, but it demolished the previously clearly defined boundaries between DCS and AGE and illustrated the shortcomings of the classification system 30. Also the Golding Classification made no provision for the dynamic nature of DI (i.e., its tendency to present in one way but evolve into another), nor could it account effectively for the wide range of clinical severity and variability in prognosis contained within the given category of 'Type II DCS'.

The main benefit of the Golding classification remains its simplicity. Unfortunately, while its application may indeed have been equally uncomplicated in the days when commercial and military diving predominated the sub aquatic realm, this is no longer applicable to the nebulous world of recreational diving and its injuries. Recent comparisons have also shown significant discordance in a retrospective application of the Golding classification to cases relevant to the spectrum of DI encountered today31-33.

Table 2.2.1-1. Modified Golding Classification for Dysbaric Illness_

• Arterial Gas Embolism

• Decompression Sickness

- Type I (Musculoskeletal Pain; Skin; Lymphatic; Extreme Fatigue; Peripheral Nervous Symptoms)

- Type II (Neurologic; Cardiorespiratory; Audiovestibular; Shock)

- Type III (Combined Decompression Sickness and Arterial Gas Embolism)

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