Moon Jinyoung, Yoo HyeKyoung
Department of Environmental Health Science, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, South Korea.
Department of Occupational and Environmental Medicine, Seoul Saint Mary's Hospital, Banpo-daero 222, Seocho-gu, Seoul, 06591, South Korea.
J Occup Med Toxicol. 2021 Aug 24;16(1):33. doi: 10.1186/s12995-021-00325-z.
There has been no comprehensive review for misdiagnosis in Occupational and Environmental Medicine (OEM). The possible ramifications of an occupational disease (OD) or an environmental disease (ED) misdiagnosis are not just confined to the individual case but may extend to others exposed to the occupational or environmental hazard. Therefore, a comprehensive scoping review of published literature is imperative for understanding the nature of misdiagnoses in OEM.
A medical librarian searched MEDLINE (PubMed), EMBASE, and the Cochrane Library (on 06 November 2020). All collected OEM misdiagnoses were classified based on 2 conceptual frameworks, the typical framework, and the causation model. The distribution of misdiagnosis across each medical specialty, each diagnostic step of the typical framework and the causation model, and false-negative and false-positive were summarized.
A total of 79 articles were included in the scoping review. For clinical specialty, pulmonology (30 articles) and dermatology or allergy (13 articles) was most frequent and second-most frequent, respectively. For each disease, occupational and environmental interstitial lung diseases, misdiagnosed as sarcoidosis (8 articles), and other lung diseases (8 articles) were most frequent. For the typical framework, the most vulnerable step was the first step, evidence of a disease (38 articles). For the causation model, the first step, knowledge base, was the most vulnerable step (42 articles). For reported articles, the frequency of false-negative (55 articles) outnumbered the frequency of false-positive (15 articles).
In OEM, compared to general medicine, causal misdiagnosis associated with the probability of causation is also important. For making a diagnosis in OEM, a knowledge base about possible ODs and EDs is essential. Because of this reason, the education and training of treating physicians for common ODs and EDs are important. For ODs and EDs, various intentional behaviors of stakeholders should be considered. This scoping review might contribute to the improvement of understanding for misdiagnosis in OEM.
职业与环境医学（OEM）领域尚未对误诊进行全面综述。职业病（OD）或环境病（ED）误诊的潜在影响不仅局限于个别病例，还可能波及其他暴露于职业或环境危害中的人群。因此，对已发表文献进行全面的范围综述对于了解OEM中误诊的本质至关重要。
医学图书馆员检索了MEDLINE（PubMed）、EMBASE和Cochrane图书馆（2020年11月6日）。所有收集到的OEM误诊案例均根据两个概念框架进行分类，即典型框架和因果模型。总结了误诊在各医学专科、典型框架和因果模型的每个诊断步骤中的分布情况，以及假阴性和假阳性情况。
范围综述共纳入79篇文章。在临床专科方面，肺病学（30篇文章）和皮肤病学或过敏学（13篇文章）分别是最常涉及和第二常涉及的领域。对于每种疾病，被误诊为结节病的职业性和环境性间质性肺病（8篇文章）以及其他肺病（8篇文章）最为常见。在典型框架中，最易出错的步骤是第一步，即疾病证据（38篇文章）。在因果模型中，第一步，知识库，则是最易出错的步骤（42篇文章）。在所报道的文章中，假阴性的频率（55篇文章）超过了假阳性的频率（15篇文章）。
在OEM中，与因果关系概率相关联的因果误诊与普通医学相比同样重要。在OEM中进行诊断时，关于可能的职业病和环境病的知识库至关重要。因此，对治疗医生进行常见职业病和环境病的教育与培训很重要。对于职业病和环境病，应考虑利益相关者的各种故意行为。本范围综述可能有助于增进对OEM中误诊的理解。
