Medical clearance for respirator use: sensitivity and specificity of a questionnaire.
Pappas-GP; Takaro-TK; Stover-B; Beaudet-N; Salazar-M; Calcagni-J; Shoop-D; Barnhart-S
Am J Ind Med 1999 Apr; 35(4):395-400
BACKGROUND: OSHA regulations require that workers receive medical clearance prior to respirator use, and recently, a detailed questionnaire has been provided to assist with this purpose. However, there are limited published data on the sensitivity and specificity of self-administered questionnaires for identifying individuals who may safely wear a respirator. METHODS: We tested 474 consecutive workers at a Department of Energy complex. After completing the self-administered questionnaire, all workers received a standardized physician evaluation including interview, physical examination, and spirometry. The outcomes of the questionnaire assessment were compared to the outcomes of physician evaluation. RESULTS: Data for analysis were available from 413 of workers (87%). All workers received medical clearance; only 10 workers (2.4%) received work restrictions. The questionnaire demonstrated 100% sensitivity in identifying workers who required work restrictions, but had specificity of only 19%. Compared to physician evaluation, the questionnaire had modest sensitivity to the detection of chronic medical conditions. CONCLUSIONS: These data suggest that the rates of medical clearance for respirator use are very high, and that a self-administered questionnaire may be appropriate for medical clearance in certain settings. It is recommended that the policy of routine physician evaluation and spirometry for respirator clearance be re-examined.
Respiratory-protection; Physical-examination; Physical-reactions; Physiological-response; Respiratory-equipment; Medical-examinations; Medical-screening; Questionnaires
Timothy K. Takaro, University of Washington, Occupational & Environmental Medicine Program, 4225 Roosevelt Way NE Suite 100, Seattle, WA 98105
American Journal of Industrial Medicine
University of Washington, Seattle, Washington