Reliability of plasma D-dimers
for predicting severe neurological decompression sickness in scuba divers.
Abstract/OtherAbstract:
BACKGROUND:
A low-grade process of coagulation activation in association with severe
neurological decompression sickness (DCS) in divers has been anecdotally
observed. We aimed to investigate whether measurement of plasma D-dimers and
other hemostatic parameters in injured scuba divers were effective as
prognostic biomarkers of neurological DCS, and we compared the diagnostic
accuracy of a combination of D-dimers test and initial clinical assessment with
either one alone.
METHODS: Eligible for the study were 84 recreational divers (69 men, 46 +/- 10 yr; 15 women, 44 +/- 8 yr) referred for neurological DCS in 2007-2011 and treated with hyperbaric oxygen. Blood tests were collected for D-dimers, fibrinogen, and platelet count with a time interval less than 8 h upon admission. Presentation severity was rated numerically for the acute event with a validated scoring system and clinical outcome was assessed by a follow-up examination at 3 mo. Indices of accuracy for D-dimers test, initial clinical score, and combination were estimated.
RESULTS: Incomplete recovery was reported in 26% of patients with a definite relationship between elevated D-dimers and presence of sequelae after multivariate analysis. We did not find differences for other blood coagulation variables between outcome groups. Combination of positive D-dimers (cut-off value of 0.40 microg x ml(-1)) with severe initial presentation attained a higher diagnostic accuracy than either method alone (post-test probabilities = 100%, 86%, and 57%, respectively).
CONCLUSION: This study suggests that determination of plasma D-dimers, a marker of activation coagulation, improve the prognostication of neurological DCS affecting scuba divers when combined with presenting severity score.
METHODS: Eligible for the study were 84 recreational divers (69 men, 46 +/- 10 yr; 15 women, 44 +/- 8 yr) referred for neurological DCS in 2007-2011 and treated with hyperbaric oxygen. Blood tests were collected for D-dimers, fibrinogen, and platelet count with a time interval less than 8 h upon admission. Presentation severity was rated numerically for the acute event with a validated scoring system and clinical outcome was assessed by a follow-up examination at 3 mo. Indices of accuracy for D-dimers test, initial clinical score, and combination were estimated.
RESULTS: Incomplete recovery was reported in 26% of patients with a definite relationship between elevated D-dimers and presence of sequelae after multivariate analysis. We did not find differences for other blood coagulation variables between outcome groups. Combination of positive D-dimers (cut-off value of 0.40 microg x ml(-1)) with severe initial presentation attained a higher diagnostic accuracy than either method alone (post-test probabilities = 100%, 86%, and 57%, respectively).
CONCLUSION: This study suggests that determination of plasma D-dimers, a marker of activation coagulation, improve the prognostication of neurological DCS affecting scuba divers when combined with presenting severity score.
Authors:
Emmanuel Gempp; Jean Morin; Pierre
Louge; Jean Eric Blatteau
Publication Detail:
Type: Journal Article
Journal Detail:
Title: Aviation, space, and
environmental medicine Volume: 83 ISSN:
0095-6562 ISO Abbreviation: Aviat Space Environ Med
Publication Date: 2012 Aug
Date Detail:
Created Date: 2012-08-09
Completed Date: - Revised
Date: -
Medline Journal Info:
Nlm Unique ID: 7501714
Medline TA: Aviat Space Environ Med
Country: United States
Other Details:
Languages: eng
Pagination: 771-5 Citation
Subset: IM; S
Affiliation:
Department
of Hyperbaric and Diving Medicine, Sainte Anne's Military Hospital, France. gempp@voila.fr
Ditayangkan
ulang olh dr.Erick Supondha (Hyperbaric&Diving Medicine Consultant) Jakarta
Indonesia, hyperbaric&diving medicine hotline 021 99070050
www.indodivinghealth.com
