The initial signs and symptoms of altitude decompression sickness

Background: With the potential for higher aircraft and cabin altitudes, the way in which altitude decompression sickness (DCS) presents continues to be of interest. The majority of previous papers on the symptom-atology of DCS are retrospective reviews of patients treated hours or days post-exposure. The initial presentation while still at altitude is the form of DCS that aircrew must be able to recognize in order to respond correctly. This paper reports the initial manifestations of DCS that occurred during a series of prospective hypobaric chamber studies. These studies had been specifically designed to investigate DCS. Methods: This paper presents a prospective analysis of DCS symptoms from 447 subjects, recorded over an 11-yr period at the Armstrong Laboratory (AL), and is an attempt to provide an accurate representation of the initial presentation of altitude DCS. Results: Of the 447 cases, 83.2% had musculoskeletal involvement, 2.7% had chokes, 2.2% skin manifestations, 10.8% paresthesia, and 0.5% frank neurological features. Conclusions: The most common presenting feature was musculoskeletal, with knee pain predominating (occurring in 70% of these cases). A very low incidence of neurological features was seen in the AL database, which was in contrast to data from many other sources. Reasons for this difference may include the use of preoxygenation and the policy of prompt recompression upon symptom development at AL. There is also the possibility that individuals in the training and operational environments are more likely to report frank neurological involvement than other forms of DCS.