HOSPITAL RECORDS - AN UNDERUTILIZED SOURCE OF INFORMATION REGARDING OCCUPATIONAL-DISEASES AND EXPOSURES

A 1993 study examined the association between pneumoconiosis and cor p ulmonary 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 avail able in hospital records. We sent abstraction forms to hospitals for 5 21 subjects who were hospitalized for pneumoconiosis, cor pulmonale, o r both conditions, requesting information regarding diagnoses, occupat ion and industry data, and X-ray results. Abstracts were received for 720 (76%) of 944 discharges that were sought. The hospital abstraction s confirmed the HMRI coding for 90% of the charts with these condition s, including 63%, 97%, and 96% of discharges for CWP, silicosis, and a sbestosis, 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 indicatin g a diagnosis of silicosis, 73% with specific dust information indicat ed silica exposure, and 95% of those for asbestosis indicated exposure to asbestos. Of 34 individuals in this data set known from the Minist ry of Labour's Chest Clinic X-ray Surveillance Program of miners to ha ve silicosis, 33 (97%) were diagnosed by the hospitals as having pneum oconiosis, and all but two were silicosis. Hospital records, as reflec ted by HMRI data, are reliable indicators of car pulmonale and pneumoc oniosis. The agreement the Chest Clinic's X-ray diagnoses provides add itional objective confirmation of the accuracy of the hospital informa tion. There were relatively few cases of silicosis miscoded as CWP. At least for pneumoconioses, hospital records contained information abou t the exposures that led to these diseases in similar to 50% of the ca ses. However, whether hospital records prove useful for detecting othe r work-related conditions that are not pathognomonic of occupation is not known. The importance of taking occupational histories needs conti nued emphasis in medical education and training. (C) 1997 Wiley-Liss, Inc.