title: Agreement between UK Maritime Coastguard Agency medical referees.
abstract: BACKGROUND
  The seafaring industry remains a hazardous occupation that requires sophisticated systems of risk and fitness assessment.
  
  
  OBJECTIVE
  To study the extent of agreement between the medical referees (MRs) and the determinants of agreement between the MRs.
  
  
  METHODS
  A total of 232,878 seafarer medical examinations were carried out by approved doctors (ADs) between 2003 and 2009. The extent of agreement between the MRs was studied in those cases considered by the MRs because the seafarer appealed against the AD's decision. The identified determinants of agreement between the MRs were analysed.
  
  
  RESULTS
  There were 465 appeal cases that covered all medical categories. Cardiovascular disease was the most frequent cause of appeal, in 31% (143) of cases. The MRs upgraded the seafarer's fitness category in 58% (271) of cases, upheld the initial AD's decision in 40% (184) and downgraded the seafarer's fitness category in only 2% (10) of cases. There was no statistically significant difference between the MRs when they assessed the fitness of seafarers.
  
  
  CONCLUSIONS
  MRs seemed to agree with each other as they upgraded the fitness category of seafarers to allow more of them to work at sea. It appears that the outcome of the appeal process was multifactorial and was affected by a combination of multiple variables.
authors.affiliation: University Hospitals Birmingham, Selly Oak - Occupational Health Department, Birmingham, UK. isamrustom@gmail.com
authors.forename: I
authors.initials: I
authors.lastname: Rustom
authors.forename: T
authors.initials: T
authors.lastname: Carter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis; D004700:Endocrine System Diseases / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009326:Naval Medicine / Q000592:standards*; D009787:Occupational Medicine / Q000592:standards*; D010808:Physical Examination / Q000592:standards*; D010809:Physical Fitness; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000592:standards; D012678:Sensation Disorders / Q000175:diagnosis; D012767:Ships; D006113:United Kingdom; D000078329:Workforce; D055815:Young Adult