Validation of death certificate diagnosis of out-of-hospital sudden cardiac death
Validation of death certificate diagnosis of out-of-hospital sudden cardiac death
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DOI：
10.1016/s0002-9149(98)00240-9
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发表时间：
1998-07-01
影响因子：
2.8
通讯作者：
Luepker, RV
中科院分区：
文献类型：
--
作者：
Iribarren, C;Crow, RS;Luepker, RV
使用6年死亡率数据（1985 - 1990），对明尼苏达州5个社区108，676名30- 74岁居民的院外心脏性猝死（OOH-SCD）死亡证明诊断的有效性进行了研究。在4，244例死亡病例中，2，035例病例的死亡地点在证书上列为医院外。其中，911人被判定为没有OOH-SCD，因为他们实际上已经住院或非心血管死亡，在剩下的1，124，254人中，使用基于医生的程序，使用临床记录，尸检报告和知情人（近亲）访谈，诊断为OOH-SCD。我们仅使用死亡证明信息，以ICD-9编码427.5（心脏骤停）加上我们医院的死亡地点简单而廉价地定义了OOH-SCD，与医生诊断相比，敏感性仅为24%，特异性为85%。当OOH-SCD的定义扩展到包括ICD编码410-414（急性心肌梗死和慢性冠状动脉疾病）时，敏感性提高到87%，而特异性变为66%。然而，即使有这种更高的灵敏度和特异性，只有27%的死亡证明标记为OOH-SCD的病例与医生的诊断一致。OOH-SCD的死亡证明诊断包括许多错误病例，可能不适合研究病因，如心律失常。死亡证明诊断可能有助于评估OOH-SCD的人群时间趋势，前提是错误分类（假阳性率）随时间保持不变。(C)1998年，Excerpta Medica，Inc.
The validity of death certificate diagnosis of out-of-hospital sudden cardiac death (OOH-SCD) was studied among 108,676 30- to 74-year-old residents in 5 Minnesota communities using 6-year mortality data (1985 to 1990). Among 4,244 total deaths, location of death was listed on the certificate as out of hospital in 2,035 cases. Of those, 911 were judged not to have OOH-SCD because they had actually been admitted to the hospital or were noncardiovascular deaths, Among the remaining 1,124, 254 were diagnosed as OOH-SCD using a thorough, physician-based procedure that used clinical records, autopsy reports, and an informant (next-of-kin) interview. We used only death certificate information to define OOH-SCD simply and inexpensively as ICD-9 code 427.5 (cardiac arrest) plus location of death listed as our-of-hospital, Compared with the physician diagnosis, sensitivity was only 24%, whereas specificity was 85%. When the definition of OOH-SCD was expanded to include ICD codes 410-414 (acute myocardial infarction and chronic coronary artery disease), sensitivity improved to 87%, whereas specificity became 66%. However, even with this higher sensitivity and specificity, only 27% of the cases labeled OOH-SCD by death certificate agreed with the physician diagnosis. Death certificate diagnosis of OOH-SCD included many erroneous cases, and may not have been suitable for study of etiologic factors, such as cardiac dysrhythmias. Death certificate diagnosis may be useful to assess population time trends in OOH-SCD, provided that misclassification (false-positive rate) remains constant over time. (C) 1998 by Excerpta Medica, Inc.