Objective To identify missed diagnosis occurrence of pneumoconiosis in four diagnosis steps of occupational health examination for dust exposed workers in Guangxi,and to provide a scientific basis to improve the quality of diagnosis of pneumoconiosis.
Methods Diagnosis of pneumoconiosis was divided into four steps:informal preliminary diagnosis,return visit,application for diagnosis,and formal diagnosis.A total of 1 265 workers were selected by cluster sampling from 23 enterprises covering eight cities of Guangxi Province who ordered occupational health examinations from 2011 to 2013.According to the national diagnostic criteria of pneumoconiosis,lung X-ray films were determined by a group of registered specialists.Occupational health monitoring records and information on pneumoconiosis diagnosis or hospital admission from municipal and provincial level medical institutions were also collected.The rates of missed diagnosis in the four steps of pneumoconiosis diagnosis were calculated.The missed diagnosis rates in return visit by diagnosis organization,enterprise properties,pre/on employment,and year of examination was assessed.
Results There were 147 cases of pneumoconiosis diagnosed in informal preliminary diagnosis step,among which 35 cases obtained the medical certificate of pneumoconiosis.The rate of missed diagnosis of pneumoconiosis was 76.2%(112/147).Specifically,the rate of missed diagnosis was 0%(0/147) for informal preliminary diagnosis,59.9%(88/147) for return visit,37.3%(22/59) for application for diagnosis,and 5.4%(2/37) for formal diagnosis.The rates of missed diagnosis in return visit varied by occupational health examination organizations and enterprise properties (χ2=60.54,P < 0.01 and χ2=112.82,P < 0.01,respectively).
Conclusion A high rate of missed diagnosis of pneumoconiosis is found in occupational health examination of dust exposed workers in Guangxi.Missed diagnosis occurs mainly in the steps of return visit and application for diagnosis.Diagnosis organizations and enterprises should be supervised to improve the quality of diagnosis of pneumoconiosisgroup
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