Hospital records: an underutilized source of information regarding occupational diseases and exposures

Our plain-English summary of Hospital records: an underutilized source of information regarding occupational diseases and exposures, by G.M. Liss, R.A. Kusiak, M.M. Gailitis (American Journal of Industrial Medicine, 1997).

The study

• Authors: G.M. Liss, R.A. Kusiak, M.M. Gailitis
• Journal: American Journal of Industrial Medicine
• Published: 1997;31(1):100-6
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

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.

In plain English

This Ontario study checked whether computerized hospital discharge codes correctly recorded pneumoconiosis and cor pulmonale (a heart condition linked to lung disease), and whether charts noted dust exposures. Hospitals abstracted charts for men aged 25 and over discharged in 1979 to 1990. The sample was all 84 subjects coded with both conditions, plus random samples of those coded with only one. In all, 715 discharges from 419 patients were analyzed. The charts confirmed the codes for 90% of charts overall, and for 67% of coal workers' pneumoconiosis, 97% of silicosis and 96% of asbestosis diagnoses. About half of silicosis and asbestosis charts recorded no specific dust exposure. Where a specific dust was identifiable, it matched the diagnosis in 40 of 42 asbestosis charts (95%), 73% of such silicosis charts and 67% of such coal workers' pneumoconiosis charts. Of 34 miners whose government chest-clinic X-rays suggested or showed silicosis, 33 had pneumoconiosis in their hospital records. The authors concluded that hospital records reliably indicate these diseases, though physicians did not record the exposure about half the time. They noted that records from earlier years were less often supplied.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Verification study re-abstracting hospital charts for a sample of discharges from a computerized hospital records database: all subjects coded with both pneumoconiosis and cor pulmonale, plus random samples of those coded with only one. Charts were compared with the database codes and with government chest-clinic X-ray results.
• Who was studied: Hospital discharges in Ontario, 1979 to 1990, of males aged 25 and over with cor pulmonale or a pneumoconiosis among the first five diagnoses. The sample sought was all 84 subjects with both conditions, 192 of 2,026 with pneumoconiosis only, and 245 of 4,300 with cor pulmonale only: 521 subjects and 944 discharges. Of these, 419 patients with 715 discharges were analyzed.
• Exposure: Occupational dust exposure inferred from the occupation and industry recorded in hospital charts. Two authors, blind to diagnoses, classified each chart as asbestos, silica, coal dust, other dust, no dust, or insufficient information.
• Main results:
  • Hospitals returned abstracts for 720 (76%) of the 944 discharges sought, representing 421 (81%) of the 521 patients
  • Overall, the database diagnoses of cor pulmonale and pneumoconiosis were confirmed for 90% of charts when discharge summaries and other chart information were both considered
  • Confirmation rates by disease were 67% for coal workers' pneumoconiosis, 97% for silicosis and 96% for asbestosis
  • Agreement between the database and the charts was very good for silicosis and asbestosis (kappas 0.84 and 0.86)
  • Of the 27 coal workers' pneumoconiosis cases not confirmed, three turned out to be silicosis
  • Of 85 charts with asbestosis, 43 (51%) had no occupation information or occupations indicating no dust or nonspecific dust exposure
  • Of the 242 silicosis charts, 120 (50%) had no occupation or industry information or were considered to represent nonspecific or no occupational dust exposure
  • Of the 42 asbestosis charts with a specific dust type, 40 (95%) indicated asbestos exposure
  • Of the 122 silicosis charts with a specific dust type, 89 (73%) were consistent with silica exposure
  • For coal workers' pneumoconiosis charts, coal dust was mentioned in 67% of those with a specific dust type
  • Of 34 individuals whose chest-clinic X-rays were interpreted as suggestive or definite silicosis, 33 (97%) had pneumoconiosis in the hospital abstraction, all but two of them silicosis
  • Agreement between a hospital diagnosis of silicosis and a chest-clinic diagnosis of definite silicosis was fair (kappa 0.38)
  • Even for these pneumoconioses, physicians did not record the occupational exposure about half of the time
• The authors' conclusion: The authors concluded that hospital records, as reflected by the HMRI data, are reliable indicators of cor pulmonale and pneumoconiosis, and that the strong association between the two diseases found with these data appears valid
• Limitations the authors state:
  • No financial incentives could be offered to hospitals, which may have limited their participation
  • Hospitals failed to supply records much more often for the earlier years of the study period
  • Sample sizes were limited by the resources available for mailings
  • Some database diagnoses may have been missing from the abstractions because hospitals worked mainly from the discharge summary
  • Usefulness of hospital records may be limited for work-related outcomes that are not pathognomonic of occupation

Topics

Medical terms in this study, explained in our Lexicon: Occupational Disease, Pneumoconiosis, Cor Pulmonale, Silicosis.

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• The effect of cigarette smoking on the detection of small radiographic opacities in inorganic dust diseases — P.D. Blanc, G. Gamsu (1988)
• Pathologica, physiological, and radiological correlations in the pneumoconioses — E.A. Gaensler, C.B. Carrington, et al. (1972)

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