Fishwick David, Bradshaw Lisa, Henson Mandy, Stenton Chris, Hendrick David, Burge Sherwood, Niven Rob, Warburton Chris, Rogers Trevor, Rawbone Roger, Cullinan Paul, Barber Chris, Pickering Tony, Williams Nerys, Ayres Jon, Curran Andrew D
Centre for Workplace Health, Health & Safety Laboratory, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK.
Occup Environ Med. 2007 Mar;64(3):185-90. doi: 10.1136/oem.2006.027722. Epub 2006 Nov 9.
To investigate the levels of agreement between expert respiratory physicians when making a diagnosis of occupational asthma.
19 cases of possible occupational asthma were identified as part of a larger national observational cohort. A case summary for each case was then circulated to 12 physicians, asking for a percentage likelihood, from the supplied information, that this case represented occupational asthma. The resulting probabilities were then compared between physicians using Spearman's rank correlation and Cohen's kappa coefficients.
Agreement between the 12 physicians for all 19 cases was generally good as assessed by Spearman's rank correlation. For all 66 physician-physician interactions, 45 were found to correlate significantly at the 5% level. The agreement assessed by kappa analysis was more variable, with a median kappa value of 0.26, (range -0.2 to +0.76), although 7 of the physicians agreed significantly (p<0.05) with >or=5 of their colleagues. Only in one case did the responses for probability of occupational asthma all exceed the "on balance" 50% threshold, although 12 of the 19 cases had an interquartile range of probabilities not including 50%, implying "on balance" agreement. The median probability values for each physician (all assessing the identical 19 cases) varied from 20% to 70%. Factors associated with a high probability rating were the presence of a positive serial peak expiratory flow Occupation Asthma SYStem (OASYS)-2 chart, and both the presence of bronchial hyper-reactivity and significant change in reactivity between periods of work and rest.
Despite the importance of the diagnosis of occupational asthma and reasonable physician agreement, certain variations in diagnostic assessment were seen between UK expert centres when assessing paper cases of possible occupational asthma. Although this may in part reflect the absence of a normal clinical consultation, a more unified national approach to these patients is required.
调查呼吸内科专家在诊断职业性哮喘时的一致性水平。
作为一个更大的全国性观察队列的一部分，确定了19例可能的职业性哮喘病例。然后将每个病例的总结分发给12位医生，要求他们根据所提供的信息，给出该病例为职业性哮喘的可能性百分比。然后使用Spearman等级相关性和Cohen卡方系数比较医生之间得出的概率。
根据Spearman等级相关性评估，12位医生对所有19例病例的一致性总体良好。在所有66次医生与医生的互动中，发现45次在5%水平上有显著相关性。通过卡方分析评估的一致性变化更大，卡方值中位数为0.26（范围为-0.2至+0.76），尽管有7位医生与≥5位同事有显著一致性（p<0.05）。只有1例职业性哮喘可能性的回答全部超过了“总体上”50%的阈值，尽管19例中有12例的概率四分位间距不包括50%，这意味着“总体上”达成了一致。每位医生（均评估相同的19例病例）的概率中位数在20%至70%之间。与高概率评级相关的因素包括呼气流量峰值序列职业性哮喘系统（OASYS）-2图表呈阳性，以及存在支气管高反应性和工作与休息期间反应性的显著变化。
尽管职业性哮喘诊断很重要且医生之间有合理的一致性，但在评估可能的职业性哮喘纸质病例时，英国各专家中心在诊断评估上仍存在一定差异。尽管这可能部分反映了缺乏正常的临床会诊，但需要一种更统一的全国性方法来处理这些患者。
