Occupational and Environmental Health Research Group, The University of Manchester, Oxford Road, Manchester, UK.
Occup Environ Med. 2010 Jul;67(7):471-8. doi: 10.1136/oem.2008.044560. Epub 2009 Nov 12.
To assess diagnostic agreement for occupational asthma, and to identify case and rater characteristics associated with this diagnosis.
Summaries of possible occupational asthma cases were sent to 104 occupational and respiratory physicians. Raters assigned likelihood scores (0-100%) of occupational asthma based on case histories (phase 1), and on histories plus investigative procedures (phase 2). Interclass correlation coefficients were calculated as statistical measures of reliability for occupational asthma scores. Comparisons between mean scores were assessed for statistical significance using tests based on multilevel models. RRs were calculated to summarise effects of raters' demographics, and of supplying investigative procedures information.
Occupational asthma scores showed limited agreement within each group of (occupational or respiratory) physicians, but scores were not systematically different. The difference between mean overall scores was 2.1% (52.1% occupational physicians; 50.0% respiratory physicians) in phase 1 (95% CI -2.6 to 6.8, p=0.37). In phase 2, mean overall scores were 46.1% (occupational physicians) and 41.5% (respiratory physicians); the difference in mean overall scores was 4.6% (95% CI -3.5 to 12.5, p=0.27). Raters with General Medical Council registration > or =1986 were more likely to give a positive occupational asthma diagnosis. In phase 2, male raters were more likely to label cases as occupational asthma than female raters (RR 4.5, 95% CI 3.3 to 6.0).
The RR of a positive occupational asthma diagnosis was unaffected by clinical specialty. Further work on why physicians consider cases to be occupational asthma will assist better diagnosis and prevention of this disease.
评估职业性哮喘的诊断一致性，并确定与该诊断相关的病例和评估者特征。
将可能的职业性哮喘病例摘要发送给 104 名职业和呼吸医师。评估者根据病例史（第 1 阶段）和病例史加调查程序（第 2 阶段），对职业性哮喘的可能性评分（0-100%）进行评分。组内相关系数被计算为职业性哮喘评分的可靠性的统计度量。使用基于多层次模型的检验来评估平均评分之间的差异是否具有统计学意义。计算相对危险度（RR）来总结评估者的人口统计学特征和提供调查程序信息对诊断结果的影响。
在每个职业或呼吸科医师组中，职业性哮喘评分的一致性有限，但评分没有系统差异。第 1 阶段（95%置信区间-2.6 至 6.8，p=0.37）中，总体评分的平均差异为 2.1%（职业医师 52.1%；呼吸医师 50.0%）。在第 2 阶段，总体评分的平均值分别为 46.1%（职业医师）和 41.5%（呼吸医师）；总体评分的平均差异为 4.6%（95%置信区间-3.5 至 12.5，p=0.27）。注册于 1986 年或之后的英国皇家内科医师学会会员的评估者更有可能给出阳性职业性哮喘诊断。在第 2 阶段，男性评估者比女性评估者更有可能将病例标记为职业性哮喘（RR 4.5，95%置信区间 3.3 至 6.0）。
阳性职业性哮喘诊断的 RR 不受临床专业的影响。进一步研究医生为何认为病例为职业性哮喘，将有助于更好地诊断和预防这种疾病。
