VALIDITY OF DEATH CERTIFICATES FOR INJURY-RELATED CAUSES OF DEATH
VALIDITY OF DEATH CERTIFICATES FOR INJURY-RELATED CAUSES OF DEATH
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DOI：
10.1093/oxfordjournals.aje.a115403
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发表时间：
1989-11-01
影响因子：
5
通讯作者：
POLLOCK, DA
中科院分区：
文献类型：
--
作者：
MOYER, LA;BOYLE, CA;POLLOCK, DA
对死亡证明信息对潜在死亡原因进行分类的有效性的探索历来集中于“自然”或与疾病相关的死亡原因。当前对伤害相关死亡的关注强调了对这些死亡进行适当认证和编码的必要性。在这项研究中，作者比较了根据死亡证明信息确定的根本死因与由一组医生对所有相关死亡医疗和法律文件进行独立审查确定的根本死因的一致性。研究样本包括随机选择的 18,313 名越战时期美国陆军退伍军人在大约 18 年随访期间（1965 年至 1983 年）内发生的所有死亡 (n = 446)。使用医师小组作为“黄金标准”，对于机动车辆碰撞死亡（国际疾病分类，第九修订版（ICD-9），代码 E810-E825）、自杀（代码 E950-E959）和他杀（代码 E960-E969）等广泛分组的敏感性和特异性为 90% 或更高。对非故意中毒死亡（代码 E850-E869）的一致性较差，主要与毒品和酒精有关（敏感性为 50%）；一般来说，ICD-9 药物和酒精特定命名法很难应用。个体三位数自杀和凶杀代码的特异性和敏感性均大于 90%，尽管三位数机动车事故死亡的特异性也高于 90%，但敏感性较低，从 29% 到 83%。对ICD-9.sbd.第四位数字的一致。例如，死者在机动车事故death.sbd.中的作用普遍较差。死亡证明上缺乏允许详细编码的描述性信息是造成一致性不佳的主要原因。
Exploration of the validity of death certificate information for classifying underlying causes of death has historically focused on "natural" or disease-related causes of death. Current interest in injury-related deaths has emphasized the need for proper certification and coding of these deaths. In this study, the authors compared agreement of the underlying cause of death as determined from death certificate information with that determined from an independent review of all relevant medical and legal documents of death by a panel of physicians. The study sample included all deaths (n = 446) occurring over an approximately 18-year follow-up period (1965-1983) in a randomly selected cohort of 18,313 US Army Veterans of the Vietnam era. Using the physician panel as the "gold standard," sensitivity and specificity were 90% or greater for broad groupings of motor vehicle crash deaths (International Classification of Diseases, Ninth Revision (ICD-9), codes E810-E825), suicides (codes E950-E959), and homicides (codes E960-E969). Agreement for deaths from unintentional poisoning (codes E850-E869), mostly drug- and alcohol-related, was poor (sensitivity, 50 percent); in general, the ICD-9 drug- and alcohol-specific nomenclature is difficult to apply. The specificity and sensitivity for the individual three-digit suicide and homicide codes were all greater than 90%, and although the specificity for three-digit motor vehicle crash deaths was also above 90%, the senstivity was lower, from 29% to 83%. Agreement on the fourth digit of ICD-9.sbd.for example, the role of the decedent in a motor vehicle crash death.sbd.was generally poor. The lack of descriptive information on death certificates to allow detailed coding was chiefly responsible for the poor agreement.