Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam.
Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam.
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DOI：
10.1186/s12874-018-0497-7
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发表时间：
2018-05-18
影响因子：
4
通讯作者：
Rao C
中科院分区：
文献类型：
--
作者：
Tran HT;Nguyen HP;Walker SM;Hill PS;Rao C
关于死因的信息对于衡量人口的健康结果和实现可持续发展目标的进展至关重要。在许多国家，如越南，民事登记和生命统计(CRVS)系统功能失调，有关生命事件的信息将继续依赖口头尸检(VA)方法。这项研究评估了越南使用的VA方法的有效性，并对在越南实施VA验证研究的方法提出了建议。这项验证研究是在广宁省最近的一项退伍军人事务部研究中进行的670例死亡样本中进行的。这项研究涵盖了这一样本中的116例病例，符合三个纳入标准：a)死亡发生在最后一次住院后30天内，b)死者的医疗记录(MRS)可从各自的医院获得，以及c)医疗记录提到患者在出院时已是绝症。对于每个死亡病例，从MRS中确定的潜在死因(UCOD)与从VA中确定的UCOD进行比较。用敏感度、特异度和阳性预测值(PPV)来衡量VA诊断主要死因的有效性。VA在识别一些主要疾病，如中风、道路交通事故和几种特定部位癌症方面的敏感度至少为75%。然而，对其他重要原因的敏感性低于50%，包括缺血性心脏病、慢性阻塞性肺疾病和糖尿病。总体而言，VA的UCOD与MR的UCOD之间的符合率为57%，当VA的多种原因与MR的UCOD进行比较时，符合率提高到76%。我们的发现表明，VA是确定越南等地UCOD的有效方法。此外，在患者宁愿死在家里而不是医疗机构的文化背景下，使用可用的MRS作为黄金标准可能有意义，因为可以最大限度地减少从最后一次出院到死亡之间的回忆偏差。因此，未来的研究应该评估MRS作为类似于越南背景的VA研究的黄金标准的有效性。本文的在线版本(10.1186/s12874-0180497-7)包含向授权用户提供的补充材料。
Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death can be minimized. Therefore, future studies should evaluate validity of MRs as a gold standard for VA studies in contexts similar to the Vietnamese context. The online version of this article (10.1186/s12874-018-0497-7) contains supplementary material, which is available to authorized users.
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