Identification of DCS risk factors in recreational diving: multifactorial model based on the DAN DSL Database 2024

Recreational diving creates risk for decompression sickness (DCS), which can occur in SCUBA diving even if current decompression algorithms are respected. The aim of this study was to identify the primary risk factors for decompression sickness in real-world regular recreational diving.

This study analyzed 127,957 dives from 5,907 divers in the DAN DSL database (version 07/2024) to identify independent risk factors for DCS in recreational diving.

Decompression sickness was reported in 628 dives, yielding an incidence rate of 0.49%. The most critical predictor was the DAN Surface Supersaturation Gradient (DSSG), with significantly higher median values in DCS dives (0.866) compared to non-DCS dives (0.743, p < 0.001). Multivariate logistic regression identified 12 independent predictors of DCS, including DSSG (logarithmic effect on odds ratio [OR]), leading compartment, female gender (OR = 4.63), lower BMI classification (OR = 0.85), reduced number of repetitive dives (OR = 0.94 per dive), shorter surface intervals (OR = 0.96 per hour), greater gas count (OR = 2.87), exercise before diving (OR = 2.06), perceived thermal comfort (OR = 2.83), workload during dive (OR = 1.61), technical dive purpose (OR = 1.36), and pre-dive fatigue perception (protective, OR = 0.30). The model showed excellent discrimination with an area under the ROC curve of 0.910 and Somer's D = 0.8287. Notably, dives using more than one gas mixture and those performed by females carried substantially increased DCS risk.

The study confirms that both physiological and operational factors influence DCS risk and provides a basis for personalized risk prediction tools in recreational diving.