Spieler E A, Barth P S, Burton J F, Himmelstein J, Rudolph L
West Virginia University College of Law, Morgantown 26506, USA.
JAMA. 2000 Jan 26;283(4):519-23. doi: 10.1001/jama.283.4.519.
The American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition, is the most commonly used tool in the United States for rating permanent impairments for disability systems. The Guides, currently undergoing revision, has been the focus of considerable controversy. Criticisms have focused on 2 areas: internal deficiencies, including the lack of a comprehensive, valid, reliable, unbiased, and evidence-based system for rating impairments; and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation. We focus on the internal deficiencies and recommend that the Guides remains a tool for evaluation of permanent impairment, not disability. To maintain wide acceptance of the Guides, its authors need to improve the validity, internal consistency, and comprehensiveness of the ratings; document reliability and reproducibility of the results; and make the Guides easily comprehensible and accessible to physicians.
美国医学协会的《永久性损伤评估指南》第四版是美国残疾评定系统中评定永久性损伤最常用的工具。目前正在修订的该《指南》一直是大量争议的焦点。批评主要集中在两个方面：一是内部缺陷，包括缺乏一个全面、有效、可靠、无偏见且基于证据的损伤评定系统；二是工伤赔偿系统使用这些评定结果的方式，导致赔偿不当。我们关注内部缺陷，并建议该《指南》仍是评估永久性损伤而非残疾的工具。为保持该《指南》被广泛接受，其作者需要提高评定结果的有效性、内部一致性和全面性；记录结果的可靠性和可重复性；并使《指南》易于医生理解和获取。
