Problems with proper completion and accuracy of the cause-of-death statement
Problems with proper completion and accuracy of the cause-of-death statement
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DOI：
10.1001/archinte.161.2.277
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发表时间：
2001-01-22
影响因子：
--
通讯作者：
Hutchins, GM
中科院分区：
文献类型：
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作者：
Sehdev, AES;Hutchins, GM
背景：死亡率统计在很大程度上基于死亡证明，因此死亡证明上的数据准确是很重要的。在我们的机构，临床医生在尸检前完成死因陈述（CODs）。自1995年5月以来，已将不同的死因列入尸检面部单。方法：采用美国病理学家学会和国家卫生统计中心公布的直接、中间和潜在死因指南和定义，对1995年6月至1997年2月间494例分别填写的临床和尸检死因报告的准确性进行比较。结果：494份死亡证明中，204份（41%）包含未正确填写的cod。其中，49例（24%）临床医生和病理学家的cod存在重大差异。在494份死亡证明中，290份（59%）正确完成了CODs。在290份正确完成的cod中，141份（49%）存在分歧：73份（52%）对基础cod存在分歧；44人（31%）使用即时cod；47人（33%）有其他重大疾病（第二部分）。结论：CODs的可靠性和准确性仍然是一个重大问题。尽管有其局限性，尸检仍然是判断死前诊断的最佳标准。如果死亡证明与尸检一起完成，并在尸检结果显示有出入时进行修改，则可以改进死亡证明的死因记录。
Background: Mortality statistics are largely based on death certificates, so it is important that the data on the death certificate is accurate. At our institution, clinicians complete cause-of-death statements (CODs) prior to autopsy. Since May 1995, separate CODs have been included in autopsy face sheets.Methods: Clinical and autopsy-based CODs filled out separately on 494 cases between June 1995 and February 1997 were compared for proper reporting and accuracy using the published guidelines and definitions of im mediate, intermediate, and underlying causes of death put forth by the College of American Pathologists and the National Center for Health Statistics.Results: Of the 494 death certificates, 204 (41%) contained improperly completed CODs. Of these, 49 (24%) contained major discrepancies between clinicians and pathologists' CODs. Of the 494 death certificates, 290 (59%) had properly completed CODs. Of the 290 properly completed CODs, 141 (49%) contained disagreements: 73 (52%) on underlying CODs; 44 (31%) on immediate CODs; and 47 (33%) on other significant conditions (part II).Conclusions: The reliability and accuracy of CODs remain a significant problem. Despite its limitations, the autopsy remains the best standard against which to judge premortem diagnoses. The CODs of the death certificate may be improved if death certificates are completed in conjunction with the postmortem examination and amended when the autopsy findings show a discrepancy.