广西省粉尘作业者职业健康检查尘肺病漏诊分析

Missed Diagnosis of Pneumoconiosis in Occupational Health Examination of Dust Exposed Workers in Guangxi

[目的]了解广西省粉尘作业者职业健康检查尘肺病诊断4个环节的漏诊情况,为改善和提高广西职业健康检查尘肺病诊断质量提供科学依据。[方法]将尘肺病诊断分为非正式尘肺病初诊、进入尘肺病复诊、申请尘肺病诊断、正式尘肺病诊断4个环节。从广西省8市2011年至2013年进行过粉尘作业职业健康检查的企业,整群抽取23家共计1 265名受检者,由具有尘肺病诊断资质的专业人员按尘肺病诊断标准集体读片,确定非正式尘肺初诊病例。查阅其职业健康监护档案资料及市级、自治区级尘肺病诊断、住院档案资料。统计粉尘作业者职业健康检查尘肺病诊断4个环节漏诊率。比较不同诊断机构、企业属性、岗前/岗中、检查年份进入尘肺病复诊环节的漏诊率。[结果]147例非正式尘肺初诊病例,35例取得尘肺病诊断证明书,广西省粉尘作业者职业健康检查尘肺病漏诊率为76.2%(112/147)。其中职业健康检查非正式尘肺病初诊环节漏诊率0%(0/147),进入尘肺病复诊环节漏诊率59.9%(88/147),申请尘肺病诊断环节漏诊率37.3%(22/59),正式诊断环节漏诊率5.4%(2/37)。不同职业健康检查机构、企业属性进入复诊环节漏诊率差异均有统计学意义(χ2=60.54,P<0.01)(χ2=112.82,P<0.01)。[结论]广西粉尘作业者职业健康检查尘肺病漏诊率较高,漏诊主要发生在进入尘肺病复诊和申请尘肺病诊断环节。应加强对尘肺病检查诊断机构及受检企业尘肺病诊断的管理。

[Objective] To identify missed diagnosis occurrence of pneumoconiosis in four diagnosis steps of occupational health examination for dust exposed workers in Guangxi, and to provide a scientific basis to improve the quality of diagnosis of pneumoconiosis. [Methods] Diagnosis of pneumoconiosis was divided into four steps ：informal preliminary diagnosis, return visit, application for diagnosis, and formal diagnosis. A total of 1 265 workers were selected by cluster sampling from 23 enterprises covering eight cities of Guangxi Province who ordered occupational health examinations from 2011 to 2013. According to the national diagnostic criteria of pneumoconiosis, lung X-ray films were determined by a group of registered specialists. Occupational health monitoring records and information on pneumoconiosis diagnosis or hospital admission from municipal and provincial level medical institutions were also collected. The rates of missed diagnosis in the four steps of pneumoconiosis diagnosis were calculated. The missed diagnosis rates in return visit by diagnosis organization, enterprise properties, pre/on employment, and year of examination was assessed. [Results] There were 147 cases of pneumoconiosis diagnosed in informal preliminary diagnosis step, among which 35 cases obtained the medical certificate of pneumoconiosis. The rate of missed diagnosis of pneumoconiosis was 76.2%（112/147）. Specifically, the rate of missed diagnosis was 0%（0/147） for informal preliminary diagnosis, 59.9%（88/147） for return visit, 37.3%（22/59） for application for diagnosis, and 5.4%（2/37） for formal diagnosis. The rates of missed diagnosis in return visit varied by occupational health examination organizations and enterprise properties（χ^2=60.54, P 〈0.01 and χ^2=112.82, P 〈0.01, respectively）. [Conclusion] A high rate of missed diagnosis of pneumoconiosis is found in occupational health examination of dust exposed workers in Guangxi. Missed diagnosis occurs mainly in the steps of return visit and application for diagnosis. Diagnosis organizations and enterprises should be supervised to improve the quality of diagnosis of pneumoconiosis.