目的了解广西市级尘肺病诊断机构诊断质量。方法对承担广西所有企业粉尘作业工人职业健康监护尘肺病诊断的全部8个市级诊断机构,每市整群取样粉尘危害严重的2~3个企业,共选取17个企业2011—2013年间一次岗前或岗中职业健康监护的全部受检者共742例,由自治区级3名有尘肺病诊断资质者与当地市有尘肺病诊断资质者共同对受检者进行尘肺病诊断及分期。此结果为检出尘肺病例。查阅有尘肺病诊断证明书者,为诊断尘肺病例。分析尘肺病诊断漏诊率、复诊漏诊率,及其与企业属性、尘肺期别、健康监护年份和时点的关系。结果检出尘肺病例72例,诊断尘肺病例34例,非尘肺误诊为尘肺病4例,尘肺误诊为非尘肺病2例。尘肺病诊断漏诊率58.3%,误诊率16.7%(χ2=16.8,P<0.01)。尘肺病初诊漏诊率为零。复诊漏诊率38.9%。壹期、贰期、叁期尘肺漏诊率分别为61.5%、33.3%、75.0%(χ2=4.22,P=0.121)。2011年漏诊率88%,2012年25%,2013年100%(χ2=33.37,P<0.01)。国营企业漏诊率0%,集体企业43%,民营企业74%(χ2=11.09,P<0.01)。复诊漏诊率民营企业61.5%,国营企业0%,集体企业13.3%(χ2=18.572,P<0.01)。岗前尘肺漏诊率47.4%,岗中62.3%(χ2=1.27,P=0.258)。岗前尘肺复诊漏诊率31.6%,岗中41.5%(χ2=0.58,P=0.446)。结论广西市级尘肺病诊断质量存在较严重问题,漏诊率高。漏诊的主要原因不是诊断技术,而是诊断管理。复诊漏诊是尘肺病漏诊的重要原因,但非唯一原因。民营企业复诊率最低,漏诊率最高,问题最突出。设立广西职业病诊断质量控制中心,加强职业病诊断科学管理;将尘肺病复诊率、尘肺病漏诊率列为广西尘肺病诊断机构诊断质量及资质认证指标,值得探索。 Objective To understand the quality of diagnosis of pneumoconiosis diagnosis in Guangxi. Methods All 8 municipal-level diagnostic institutions responsible for the occupational health monitoring of pneumoconiosis among workers in dust-polluting industries in Guangxi were surveyed, and 2 to 3 enterprises, each of which had a serious risk of sampling dust in each municipality, selected 17 enterprises from 2011 to 2013 Before or during occupational health monitoring of all subjects were a total of 742 cases by the autonomous region-level three pneumoconiosis diagnostic qualification and the local city of pneumoconiosis diagnostic qualification of subjects with pneumoconiosis diagnosis and staging. This result is detected pneumoconiosis cases. Check the diagnosis of pneumoconiosis who, for the diagnosis of pneumoconiosis cases. Analysis of pneumoconiosis diagnosis misdiagnosis rate, referral diagnosis rate of misdiagnosis, and its relationship with the enterprise attributes, pneumoconiosis, health monitoring year and time point. Results 72 cases of pneumoconiosis were detected, 34 cases of pneumoconiosis were diagnosed, 4 cases of non-pneumoconiosis misdiagnosed as pneumoconiosis and 2 cases of pneumoconiosis misdiagnosed as non-pneumoconiosis. The missed diagnosis rate of pneumoconiosis was 58.3%, misdiagnosis rate was 16.7% (χ2 = 16.8, P <0.01). Pneumoconiosis diagnosis of missed diagnosis rate of zero. Referral missed the rate of 38.9%. The missed diagnosis rates of pneumoconiosis in stage I, stage II and stage III were 61.5%, 33.3% and 75.0% respectively (χ2 = 4.22, P = 0.121). The rate of misdiagnosis was 88% in 2011, 25% in 2012 and 100% in 2013 (χ2 = 33.37, P <0.01). The rate of misdiagnosis in state-owned enterprises was 0%, that of collective enterprises was 43%, and that of private enterprises was 74% (χ2 = 11.09, P <0.01). The rate of missed referral was 61.5% for private enterprises, 0% for state-owned enterprises and 13.3% for collective enterprises (χ2 = 18.572, P <0.01). Pneumoconiosis missed 47.4% in post and 62.3% in post (χ2 = 1.27, P = 0.258). The missed diagnosis rate of post-pneumoconiosis patients was 31.6% and 41.5% (χ2 = 0.58, P = 0.446). Conclusion There is a serious problem in the quality of diagnosis of pneumoconiosis in Guangxi and the rate of misdiagnosis is high. The main reason for missed diagnosis is not diagnostic techniques, but diagnostic management. Referral missed diagnosis is an important cause of missed diagnosis of pneumoconiosis, but not the only reason. The lowest referral rate of private enterprises, the highest rate of missed diagnosis, the most prominent problem. The establishment of Guangxi Occupational Disease Diagnostic Quality Control Center to strengthen the scientific management of occupational disease diagnosis; the pneumoconiosis referral rate, pneumoconiosis diagnosis rate as a diagnosis of pneumoconiosis diagnosis quality and qualification index, it is worth exploring.