Liss G M, Kusiak R A, Gailitis M M
Health and Safety Studies Unit, Ontario Ministry of Labour, Toronto, Canada.
Am J Ind Med. 1997 Jan;31(1):100-6. doi: 10.1002/(sici)1097-0274(199701)31:1<100::aid-ajim15>3.0.co;2-6.
A 1993 study examined the association between pneumoconiosis and cor pulmonale using a computerized data base of hospital records in Ontario (Hospital Medical Records Institute, HMRI). The present investigation was undertaken to confirm the coding of the diagnoses of a subset of the hospital discharges from that study, to determine the validity of the coding of the diagnoses of coal workers' pneumoconiosis (CWP), and to identify work exposure (occupation and industry) information available in hospital records. We sent abstraction forms to hospitals for 521 subjects who were hospitalized for pneumoconiosis, cor pulmonale, or both conditions, requesting information regarding diagnoses, occupation and industry data, and X-ray results. Abstracts were received for 720 (76%) of 944 discharges that were sought. The hospital abstractions confirmed the HMRI coding for 90% of the charts with these conditions, including 63%, 97%, and 96% discharges for CWP, silicosis, and asbestosis, respectively. Specific dust exposures were indicated in 42% of the charts with a code indicating a diagnosis of CWP, and of these, 67% indicated exposure to coal dust. Of charts with a code indicating a diagnosis of silicosis, 73% with specific dust information indicated silica exposure, and 95% of those for asbestosis indicated exposure to asbestos. Of 34 individuals in this data set known from the Ministry of Labour's Chest Clinic X-ray Surveillance Program of miners to have silicosis, 33 (97%) were diagnosed by the hospitals as having pneumoconiosis, and all but two were silicosis. Hospital records, as reflected by HMRI data, are reliable indicators of cor pulmonale and pneumoconiosis. The agreement with the Chest Clinic's X-ray diagnoses provides additional objective confirmation of the accuracy of the hospital information. There were relatively few cases of silicosis miscoded as CWP. At least for pneumoconioses, hospital records contained information about the exposures that led to these diseases in approximately 50% of the cases. However, whether hospital records would prove useful for detecting other work-related conditions that are not pathognomonic of occupation is not known. The importance of taking occupational histories needs continued emphasis in medical education and training.
1993年的一项研究利用安大略省的医院记录计算机数据库（医院医疗记录研究所，HMRI），调查了尘肺病与肺心病之间的关联。本次调查旨在确认该研究中部分医院出院诊断的编码，确定煤工尘肺（CWP）诊断编码的有效性，并识别医院记录中可用的工作暴露（职业和行业）信息。我们向医院发送了521名因尘肺病、肺心病或两种疾病住院的患者的摘要表，要求提供有关诊断、职业和行业数据以及X线检查结果的信息。在944份寻求摘要的出院记录中，收到了720份（76%）。医院摘要确认了90%患有这些疾病病历的HMRI编码，其中CWP、矽肺和石棉肺的出院记录分别为63%、97%和96%。42%诊断为CWP的病历中显示了特定的粉尘暴露，其中67%表明暴露于煤尘。在诊断为矽肺的病历中，73%有特定粉尘信息的病历表明暴露于二氧化硅，而石棉肺病历中有95%表明暴露于石棉。在该数据集中，从劳工部矿工胸部诊所X线监测项目得知有34人患有矽肺，其中33人（97%）被医院诊断为患有尘肺病，除两人外均为矽肺。正如HMRI数据所反映的，医院记录是肺心病和尘肺病的可靠指标。与胸部诊所X线诊断的一致性为医院信息的准确性提供了额外的客观证实。被误编码为CWP的矽肺病例相对较少。至少对于尘肺病，医院记录在大约50%的病例中包含了导致这些疾病的暴露信息。然而，医院记录是否对检测其他与工作相关但并非职业特征性的疾病有用尚不清楚。在医学教育和培训中，持续强调采集职业病史的重要性仍很有必要。
