How about the whole article then as your quote is out of context and you can already see renowned establishments starting to use it.You seem to have conveniently missed out the start with "time to accept reality" and the summation "However, when classifying an individual patient the inherent uncertainty is best reflected by the term decompression illness."
It is no wonder why you may be having issues coming to terms with this.
lol, You give a whole new meaning to the term "DCI Denial
Trux, be aware it could all change next weeK. When I go back here in a few months I will ask
The National Hyperbaric Centre
Here is the whole article:
Classification of the decompression disorders:
time to accept reality
Richard E. Moon, M.D. Durham, North Carolina
The constellation of signs and symptoms associated with a reduction in ambient pressure was first observed in compressed air workers in the 19th century and was called "compressed air illness" or "caisson disease." Similar signs and symptoms were subsequently observed in divers breathing compressed air and were referred to as "diver's paralysis" or "diver's palsy." Early in this century the elucidation of the pathophysiology of this disorder led to the terms "decompression sickness" (DCS) for in situ bubble formation caused by inert gas supersaturation, and "arterial gas embolism" (AGE) for intravascular gas due to pulmonary over-pressurization.
In 1960, in reference to compressed air workers, Golding classified decompression sickness as "type I," referring to cases exhibiting only pain, and "type II," in which there were symptoms other than pain, or abnormal physical signs, including neurological manifestations (1). This sub-classification (type I DCS, type II DCS, and arterial gas embolism) has been used by the US Navy (USN) as a guide to diagnosis and treatment. According to the USN algorithm, type I DCS is to be treated under certain conditions with USN Table 5, whereas type II requires USN Table 6. The recommended treatment for AGE was USN Table 6A. For the majority of cases this treatment algorithm has been efficacious, and it has been widely accepted. Epidemiologic data pertinent to divers have traditionally not been recorded in sufficient detail to allow a more specific classification. However, as long as the majority of cases were associated with commercial or military diving there was no need to do so. Prediction of outcome and triaging were unnecessary, since chambers were available on site, and in the vast majority of cases in which recompression treatment was administered shortly after the onset of symptoms there was complete resolution. As a descriptive and epidemiologic tool, however, the "type I/type II" scheme has been lacking. The type II classification encompasses a huge spectrum of disease, ranging from paresthesias to quadriplegia. Furthermore, a universally accepted definition of the two types of DCS does not exist. Whereas type I in the Golding scheme includes only pain, the USN definition encompasses skin and Iymphatic manifestations (2). Type II has also some times been extended to include type I symptoms that occur during decompression. Both types are mutually exclusive in the Golding classification while the USN Diving Manual refers to types I and II symptoms and allows both types to coexist. Because of such inconsistencies it is impossible to methodically compare published series of diving accidents, as authors often do not define the manner in which they use the classification. In recent years, the usefulness of this traditional classification scheme has declined, due to several factors. First has been the growth of civilian recreational diving and the associated accidents, where often 24 h or more delay before recompression therapy is typical, and the outcome after treatment is less than uniformly successful. Second is the recognition of the difficulty of accurately classifying cases of decompression-associated symptoms. The traditional classification scheme is frequently applied inconsistently and incorrectly, undoubtedly in part due to the difficulty of ascertaining the exact cause of a diving accident (DCS vs. AGE). The diver may not remember, and the buddy has often not observed the breathing pattern during ascent. The clinical picture may be similarly unrevealing: gas embolism superimposed upon tissues with a significant inert gas load may result in a clinical presentation that resembles DCS rather than AGE. Third, the distinction between DCS and AGE has been further blurred by the realization that arterial bubbles probably contribute to the pathophysiology of decompression sickness in settings other than pulmonary barotrauma. Finally, the previously close relationship between DCS classification and choice of treatment table has now become less distinct. Many civilian diving physicians now treat all types of DCS with USN Table 6, irrespective of their classification, and the US Navy Diving Manual now recommends that recompression treatment of both DCS and AGE should begin at 60 fsw (18 msw). Even in USN practice, the only remaining therapeutic use for the old classification is to decide whether USN Table 5 can be utilized (i.e., to classify decompression sickness into "type I" and "non-type I"). If the old classification is to be discarded, with what should it be replaced? To reexamine the issue of diagnostic terminology, a workshop was held in 1990 in which there was a consensus in favor of abolishing the classification based on etiology (AGE vs. DCS) (3). The workshop participants recognized the difficulty of determining accurately the pathophysiology of decompression accidents and accepted the all-encompassing term decompression illness (DCI). While no new concept is engendered by this simple semantic change, it permits reference to gas bubble disease without requiring any insight into pathophysiology, as is implied when "decompression sickness" or "arterial gas embolism" are used. It was further proposed that it would be more appropriate to describe DCI descriptively, according to onset, evolution, and some estimation (e.g., depth-time profile) of inert gas load. The various reasons for classification of any disease include the need to predict prognosis and susceptibility to treatment and to design treatment algorithms. Identification of subsets that are particularly amenable or resistant to treatment is essential for the design of clinical trials. In the literature on neurologic bends it is impossible to identify such subsets because such a wide spectrum of disease is lumped into the category type II DCS. However, recent studies have demonstrated the feasibility of identifying such subsets by sub-classifying neurologic bends according to severity (4,5). It is traditional in medicine to attempt to classify diseases according to causation. However, in the absence of a unified knowledge of pathophysiology, many classification schemes in current use in other medical disciplines incorporate symptoms or signs, for example schizophrenia, lymphoma, migraine, and leprosy. The availability of a specific diagnostic procedure which can differentiate subsets (the usual requirement for classification of individuals cases by etiology) is missing for such entities, as well as, for the present, the decompression disorders. Irrespective of whether the data structure suggested by Francis and Smith (3) is the best one, to allude to either DCS or AGE, "decompression illness" is unquestionably a useful shorthand term requiring no insight into the pathogenesis of a particular case of gas bubble disease. Indeed, it has been widely accepted as such. The term "DCI" has been embraced by organizations whose task it is to collect epidemiologic data as well as by scientists and clinicians. A literature search at the time of writing reveals 35 indexed publications using the term "decompression illness." The development of large databases containing detailed information about symptomatology now makes available the tools necessary to examine the possibility that a new classification system, for example, frequent clustering of symptoms, or even better, response to treatment and long-term outcome, might be more clinically useful than the present one. Just such an approach was used to develop a classification for the muscular dystrophies (6). Whether decompression disorders are amenable to similar analysis is an unanswered question, but even to attempt it would require more detail than is available in the present classification.
Accepting the term "DCI" does not imply that the old terminology "DCS" and "AGE" should be eliminated. These terms are unambiguous and perfectly appropriate for denoting the pathophysiologic concepts for which they were defined. However, when classifying an individual patient the inherent uncertainty is best reflected by the term decompression illness.
REFERENCES
1. Golding F, Griffiths P, Hempleman HV, Paton WDM, Walder DN. Decompression sickness during construction of the Dartford Tunnel. Br J Ind Med 1960; 17:167-180.
2. Navy Department. US Navy Diving Manual, vol. 1 revision 3. Air diving. NAVSEA 0994-LP-001-9110. Flagstaff, AZ: Best Publishing, 1993.
3. Francis TJR, Smith DJ, editors. Describing decompression illness. Kensington, MD: Undersea and Hyperbaric Medical Society,1991.
4. Kelleher PC, Pethybridge RJ, Francis TJR. Outcome of neurologicaL decompression illness: development of a manifestation-based model. Aviat Space Environ Med 1996; 67:654 65B.
5. Ball R. Effect of severity, time to recompression with oxygen, and retreatment on outcome in forty-nine cases of spinal cord decompression sickness. Undersea Hyperbaric Med 1993; 20:133-145.
6. Walton JN, Nattrass FJ. On the classification, natural history and treatment of the myopathies. Brain 1954; 77:169-231.
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