The SANDHOG criteria and its validation for the diagnosis of DCS arising from bounce diving.

Purpose: A three-point scale, the SANDHOG (SAN Diego Diving and Hyperbaric Organizations) criteria, was developed to diagnose DCS (decompression sickness), and then it was validated against a known database of diving related injuries.

Introduction: There are currently no universally accepted diagnostic criteria for the diagnosis of DCS. The SANDHOG criteria were developed to address the need for a case definition of DCS.

Methods: A point scale and entrance criteria were developed for the diagnosis of DCS. Once the entrance criterion had been met, points were awarded based upon the diver's symptoms and their time of onset. The point system and time limits (SANDHOG criteria) were determined based upon US Navy and Royal Canadian diving reports. The SANDHOG criteria were then applied on a post hoc basis to the Duke Hyperbaric database of diving injuries. Sensitivity and specificity were then calculated using three points as the cut off. The ROC (receiver operating characteristic) analysis was performed to determine the area under the curve (AUC).

Results: The three point SANDHOG criteria had a specificity of 90.3% and a sensitivity of 52.7%. ROC analysis of the original SANDHOG criteria gave an AUC of 0.72. Using different point values for the diagnosis of DCS will subsequently affect the sensitivity and specificity of the SANDHOG criteria.

Conclusions: The specificity of the SANDHOG criteria is good, and demonstrates that the SANDHOG criteria are a useful tool for the diagnosis of DCS.