SHORT COMMUNICATION
International classification of diseases and diving illnesses Surg Lt Cdr Rohit Verma* MJAFI 2012;68:61–62 Key Words: diving; international statistical classification of diseases
INTRODUCTION
DIVING ILLNESSES AND THEIR REPRESENTATION IN ICD-10
International statistical classification of diseases (ICD) and related health problems is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO).1 Its 10th version is in vogue and is abbreviated as ICD-10. The purpose of the ICD is to permit the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in different countries or areas and at different times. It is used to translate diagnoses and other health-related problems from words into an alpha numeric code, which permits easy storage, retrieval, and analysis of data. In practice, the ICD has become the international standard diagnostic classification for all general epidemiological studies and many health management purposes. These include the analysis of the general health situation of population groups and the monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables, such as the characteristics and circumstances of the individuals affected.2 Further, it has also been used for many purposes, with certain modifications, that it was not initially intended to be, for example, studies of financial aspects, such as billing or resource allocation, health insurance, for specific health specialties like psychiatry, and for the Armed Forces Medical Services (AFMS). Hence, any illness or group of disorders not catered for in the ICD, remains outside the pale of statistical analyses and health management systems. One such group is diving-related illnesses, which have not been adequately represented in either the ICD-10 or its adapted version for the Indian AFMS.3
Illnesses Specific to Diving Mentioned in the ICD-10 Decompression sickness (DCS), osteonecrosis in DCS, certain barotraumas like aural and sinus; and being in a low-on-air (LOA) or out-of-air (OOA) situations, which are specific to diving, are mentioned in the ICD-10, as depicted in Table 1. However, in the adaptation for the Indian AFMS,3 all these have been omitted and only one entry pertaining to ‘exposure to high and low air pressure and changes in air pressure’ as W 94 is present.
Table 1 International statistical classification of diseases-10 nomenclatures for diving-related illnesses.
*Graded Specialist (Marine Medicine) & PMO, INS Nireekshak, C/o Fleet Mail Office, Kochi – 682004. Correspondence: Surg Lt Cdr Rohit Verma, Graded Specialist (Marine Medicine) & PMO, INS Nireekshak, C/o Fleet Mail Office, Kochi – 682004. E-mail: [email protected] Received: 05.07.2010; Accepted: 04.10.2011 doi: 10.1016/S0377-1237(11)60142-1
MJAFI Vol 68 No 1
S. no. 1 2
ICD no. M 90.3 T 41.5
3 4 5 6 7
T 70 T 70.0 T 70.1 T 70.3 T 70.9
8
T 58
9 10 11
T 68 W 56 W 81
12
W 94
13
X 26
14
Y 36
Nomenclature Osteonecrosis in caisson disease Poisoning by therapeutic gases; oxygen and carbon dioxide Effects of air pressure and water pressure Otitic barotrauma Sinus barotrauma Caisson disease (decompression sickness) Effects of air pressure and water pressure, unspecified Toxic effects of carbon monoxide from all sources Hypothermia Contact with marine animal Confined to or trapped in a low oxygen environment including diving with insufficient air supply Exposure to high and low air pressure and changes in air pressure Contact with venomous marine animals and plants War operations involving explosion of marine weapons
ICD: International Statistical Classification of Diseases.
61
© 2012, AFMS
Verma
Nonspecific Illnesses Related to Diving Mentioned in the ICD-10 Oxygen toxicity, carbon dioxide toxicity, hypothermia, marine animal injuries, and war trauma have been mentioned in the ICD-10 as depicted in Table 1. However, these do not strictly follow the concept of ‘family’ of disease2 enunciated in the ICD-10. Hence, statistical analyses of diving disorders using these ‘family’ trees are limited. The Armed Forces adaptation3 omits all these illnesses.
clubbed as ‘drowning’, for lack of a more descriptive nomenclature. This anomaly may be addressed in the forthcoming 11th revision of the ICD (ICD-11), by making a specific category for occupational illnesses, with diving illnesses being a sub-category and adhering to the concept of ‘family’ of diseases on the basis of a shared aetiopathology. Further, the Armed Forces adaptation of the ICD-10 should also have the entries of the illnesses related to diving, as they are extremely relevant in the Armed Forces environment.
Diving-related Illnesses Required to be Entered into ICD-10 This leaves a lot of diving-related illness to be included in the ICD-10. These include: inert gas narcosis, high pressure nervous syndrome and pulmonary barotrauma. Also, variations of many illnesses manifesting as a consequence of diving, such as alternobaric vertigo, needs to be enunciated in the ICD. Further, many variations and sequelae of DCS and arterial gas embolism (AGE) such as, isobaric counter diffusion, taravana, and cutis marmorata need to be added to the relevant category.
CONFLICTS OF INTEREST None identified.
REFERENCES 1.
CONCLUSION 2.
Diving illnesses are a unique group of disorders which have been inadequately represented in the ICD and its various adaptations including the one for the Indian AFMS. This entails statistical difficulties and lack of cohesion during epidemiological analyses of diving-related illnesses. One such problem being, all in water diving-related mortality, is most of the times
MJAFI Vol 68 No 1
3.
62
World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death. Volume 1. Geneva: WHO 1977. World Health Organization. International statistical classification of diseases and related health problems (ICD-10) 10th Revision. Volume 2. 2nd ed. Geneva: WHO 2004. International Statistical Classification of Diseases and Related Health Problems – 2002 (ICD-10) 10th Revision. Adopted for the Armed Forces Medical Services. Delhi: The Director General Armed Forces Medical Services 2002.
© 2012, AFMS
International classification of diseases and diving illnesses Surg Lt Cdr Rohit Verma* MJAFI 2012;68:61–62 Key Words: diving; international statistical classification of diseases
INTRODUCTION
DIVING ILLNESSES AND THEIR REPRESENTATION IN ICD-10
International statistical classification of diseases (ICD) and related health problems is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO).1 Its 10th version is in vogue and is abbreviated as ICD-10. The purpose of the ICD is to permit the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in different countries or areas and at different times. It is used to translate diagnoses and other health-related problems from words into an alpha numeric code, which permits easy storage, retrieval, and analysis of data. In practice, the ICD has become the international standard diagnostic classification for all general epidemiological studies and many health management purposes. These include the analysis of the general health situation of population groups and the monitoring of the incidence and prevalence of diseases and other health problems in relation to other variables, such as the characteristics and circumstances of the individuals affected.2 Further, it has also been used for many purposes, with certain modifications, that it was not initially intended to be, for example, studies of financial aspects, such as billing or resource allocation, health insurance, for specific health specialties like psychiatry, and for the Armed Forces Medical Services (AFMS). Hence, any illness or group of disorders not catered for in the ICD, remains outside the pale of statistical analyses and health management systems. One such group is diving-related illnesses, which have not been adequately represented in either the ICD-10 or its adapted version for the Indian AFMS.3
Illnesses Specific to Diving Mentioned in the ICD-10 Decompression sickness (DCS), osteonecrosis in DCS, certain barotraumas like aural and sinus; and being in a low-on-air (LOA) or out-of-air (OOA) situations, which are specific to diving, are mentioned in the ICD-10, as depicted in Table 1. However, in the adaptation for the Indian AFMS,3 all these have been omitted and only one entry pertaining to ‘exposure to high and low air pressure and changes in air pressure’ as W 94 is present.
Table 1 International statistical classification of diseases-10 nomenclatures for diving-related illnesses.
*Graded Specialist (Marine Medicine) & PMO, INS Nireekshak, C/o Fleet Mail Office, Kochi – 682004. Correspondence: Surg Lt Cdr Rohit Verma, Graded Specialist (Marine Medicine) & PMO, INS Nireekshak, C/o Fleet Mail Office, Kochi – 682004. E-mail: [email protected] Received: 05.07.2010; Accepted: 04.10.2011 doi: 10.1016/S0377-1237(11)60142-1
MJAFI Vol 68 No 1
S. no. 1 2
ICD no. M 90.3 T 41.5
3 4 5 6 7
T 70 T 70.0 T 70.1 T 70.3 T 70.9
8
T 58
9 10 11
T 68 W 56 W 81
12
W 94
13
X 26
14
Y 36
Nomenclature Osteonecrosis in caisson disease Poisoning by therapeutic gases; oxygen and carbon dioxide Effects of air pressure and water pressure Otitic barotrauma Sinus barotrauma Caisson disease (decompression sickness) Effects of air pressure and water pressure, unspecified Toxic effects of carbon monoxide from all sources Hypothermia Contact with marine animal Confined to or trapped in a low oxygen environment including diving with insufficient air supply Exposure to high and low air pressure and changes in air pressure Contact with venomous marine animals and plants War operations involving explosion of marine weapons
ICD: International Statistical Classification of Diseases.
61
© 2012, AFMS
Verma
Nonspecific Illnesses Related to Diving Mentioned in the ICD-10 Oxygen toxicity, carbon dioxide toxicity, hypothermia, marine animal injuries, and war trauma have been mentioned in the ICD-10 as depicted in Table 1. However, these do not strictly follow the concept of ‘family’ of disease2 enunciated in the ICD-10. Hence, statistical analyses of diving disorders using these ‘family’ trees are limited. The Armed Forces adaptation3 omits all these illnesses.
clubbed as ‘drowning’, for lack of a more descriptive nomenclature. This anomaly may be addressed in the forthcoming 11th revision of the ICD (ICD-11), by making a specific category for occupational illnesses, with diving illnesses being a sub-category and adhering to the concept of ‘family’ of diseases on the basis of a shared aetiopathology. Further, the Armed Forces adaptation of the ICD-10 should also have the entries of the illnesses related to diving, as they are extremely relevant in the Armed Forces environment.
Diving-related Illnesses Required to be Entered into ICD-10 This leaves a lot of diving-related illness to be included in the ICD-10. These include: inert gas narcosis, high pressure nervous syndrome and pulmonary barotrauma. Also, variations of many illnesses manifesting as a consequence of diving, such as alternobaric vertigo, needs to be enunciated in the ICD. Further, many variations and sequelae of DCS and arterial gas embolism (AGE) such as, isobaric counter diffusion, taravana, and cutis marmorata need to be added to the relevant category.
CONFLICTS OF INTEREST None identified.
REFERENCES 1.
CONCLUSION 2.
Diving illnesses are a unique group of disorders which have been inadequately represented in the ICD and its various adaptations including the one for the Indian AFMS. This entails statistical difficulties and lack of cohesion during epidemiological analyses of diving-related illnesses. One such problem being, all in water diving-related mortality, is most of the times
MJAFI Vol 68 No 1
3.
62
World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death. Volume 1. Geneva: WHO 1977. World Health Organization. International statistical classification of diseases and related health problems (ICD-10) 10th Revision. Volume 2. 2nd ed. Geneva: WHO 2004. International Statistical Classification of Diseases and Related Health Problems – 2002 (ICD-10) 10th Revision. Adopted for the Armed Forces Medical Services. Delhi: The Director General Armed Forces Medical Services 2002.
© 2012, AFMS
