Telemedicine in the management of diving accidents: correlation of phone-assessed symptom severity with clinical findings.

Introduction: The object of this study was to evaluate to what extend the severity of decompression illness (DCI) assessed by a diving medicine specialist over the phone correlates with actual clinical findings.

Methods: The phone protocols of calls received by a diving medical hotline between January 2008 and December 2009 were analysed. Each case was followed up after completion of the treatment and categorized into one out of four severity groups according to the same standard protocol used for categorisation at the time of the initial hotline call.

Results: In 47 of 151 calls, DCI was suspected by the hotline experts. The initial estimation was coherent with the clinical findings in 37 cases, 9 were overestimated and one was underestimated. With the 95% bootstrap confidence interval 0.551 to 0.864 and computed weighted Cohen's κ coefficient = 0,721, the coherence between hotline assessment and clinical assessment can be considered as good. The five divers with minimal symptoms who were categorised as "no DCI possible" could not be followed up.

Conclusion: We conclude that, despite some limitations to the study, particularly the limited sample size, a reliable assessment of the severity of DCI can be provided by a specialist-based telephone hotline.