Death certificate errors in three teaching hospitals of Zahedan, southeast of Iran

Misclassification of causes of death among a small all-autopsied group of former nuclear workers: Death certificates vs. autopsy reports

The U.S. Transuranium and Uranium Registries performs autopsies on each of its deceased Registrants as a part of its mission to follow up occupationally-exposed individuals. This provides a unique opportunity to explore death certificate misclassification errors, and the factors that influence them, among this small population of former nuclear workers. Underlying causes of death from death certificates and autopsy reports were coded using the 10th revision of the International Classification of Diseases (ICD-10). These codes were then used to quantify misclassification rates among 268 individuals for whom both full autopsy reports and death certificates with legible underlying causes of death were available. When underlying causes of death were compared between death certificates and autopsy reports, death certificates correctly identified the underlying cause of death's ICD-10 disease chapter in 74.6% of cases. The remaining 25.4% of misclassified cases resulted in over-classification rates that ranged from 1.2% for external causes of mortality to 12.2% for circulatory disease, and under-classification rates that ranged from 7.7% for external causes of mortality to 47.4% for respiratory disease. Neoplasms had generally lower misclassification rates with 4.3% over-classification and 13.3% under-classification. A logistic regression revealed that the odds of a match were 2.8 times higher when clinical history was mentioned on the autopsy report than when it was not. Similarly, the odds of a match were 3.4 times higher when death certificates were completed using autopsy findings than when autopsy findings were not used. This analysis excluded cases where it could not be determined if autopsy findings were used to complete death certificates. The findings of this study are useful to investigate the impact of death certificate misclassification errors on radiation risk estimates and, therefore, improve the reliability of epidemiological studies.

Prevalence of maternal mortality causes based on ICD-MM: a systematic review and meta-analysis

BACKGROUND

Maternal mortality is a universal public health challenge. ICD-Maternal Mortality (ICD-MM) was introduced in 2012 to facilitate the gathering, analysis, and interpretation of data on maternal deaths worldwide. The present study aimed to estimate the global prevalence of maternal death causes through a systematic review and meta-analysis.

METHODS

A systematic literature search was conducted using various databases, including Web of Science, PubMed, Scopus, ScienceDirect, Cochrane Library, as well as Persian databases such as MagIran and Scientific Information Database (SID). The search encompassed articles published until August 21, 2022. Thirty-four eligible articles were included in the final analysis. Analysis was performed using a meta-analysis approach. The exact Clopper-Pearson confidence intervals, heterogeneity assessment, and random effects models with Mantel-Haenszel methods were employed using the STATA software version 14.2.

RESULTS

The most prevalent causes of maternal deaths, listed in descending order from highest to lowest prevalence, were non-obstetric complications (48.32%), obstetric hemorrhage (17.63%), hypertensive disorders of pregnancy, childbirth, and the puerperium (14.01%), other obstetric complications (7.11%), pregnancy with abortive outcome (5.41%), pregnancy-related infection (5.26%), unanticipated complications of management (2.25%), unknown/undetermined causes (2.01%), and coincidental causes (1.59%), respectively.

CONCLUSION

Non-obstetric complications, obstetric hemorrhage, and hypertensive disorders of pregnancy, childbirth, and puerperium were the most common causes of maternal deaths. To reduce the burden of maternal mortality causes, increasing awareness and promoting self-care management among women of reproductive age, and implementing effective screening mechanisms for high-risk mothers during pregnancy, childbirth, and the puerperium can play a significant role. ICD-MM enables the uniform collection and comparison of maternal death information at different levels (local, national, and international) by facilitating the consistent collection, analysis, and interpretation of data on maternal deaths. Our findings can be utilized by policymakers and managers at various levels to facilitate necessary planning aimed at reducing the burden of maternal mortality causes.

Quality of death certificates completion for COVID-19 cases in the southeast of Iran: A cross-sectional study

Background and Aim

Death certificate (DC) data provides a basis for public health policies and statistics and contributes to the evaluation of a pandemic's evolution. This study aimed to evaluate the quality of the COVID-19-related DC completion.

Methods

A descriptive-analytical study was conducted to review a total of 339 medical records and DCs issued for COVID-19 cases from February 20 to September 21, 2020. A univariate analysis (χ 2 as an unadjusted analysis) was performed, and multiple logistic regression models (odd ratio [OR] and 95% confidence interval [CI] as adjusted analyses) were used to evaluate the associations between variables.

Results

Errors in DCs were classified as major and minor. All of the 339 examined DCs were erroneous; more than half of DCs (57.8%) had at least one major error; all of them had at least one minor error. Improper sequencing (49.3%), unacceptable underlying causes of death (UCOD) (33.3%), recording more than one cause per line (20.1%), listing general conditions instead of specific terms (11.2%), illegible handwriting (8.3%), competing causes (6.2%), and mechanisms (3.8%) were most common major errors, respectively. Absence of time interval (100%), listing mechanism allying with UCOD (51.6%), using abbreviations (45.4%), missing major comorbidities (16.5%), and listing major comorbidities in part I (16.5%) were most common minor errors, respectively.

Conclusion

The rate of both major and minor errors was high. Using automated tools for recording and selecting death cause(s), promoting certifiers' skills on DC completion, and applying quality control mechanisms in DC documentation can improve death data and statistics.

Factors Associated with Major Errors on Death Certificates

The objective of this study was to investigate errors on death certificates and factors associated with the occurrence of major errors. A retrospective analysis was conducted for six months in 2020 at a university training hospital. Errors were judged as major and minor errors according to the contribution to the process of determining the cause of death. Death certificates were classified into two groups with major errors (ME group) and without major errors (non-ME group). General characteristics of the death certificates, the main cause of death (cancer, cardiovascular disease, cerebrovascular disease, digestive disease, respiratory disease, genitourinary disease, intentional self-harm, external causes, and other causes), the number of causes of deaths written on the death certificate, and major and minor errors were investigated. The ME group had 127 cases out of 548 death certificates. The number of causes of deaths written on the death certificates and the total number of errors were higher in the ME group than in the non-ME group. Cardiovascular disease, cerebrovascular disease, digestive disease, respiratory disease, external causes, and other diseases as causes of deaths had higher risks of major errors on death certificates than cancer as a cause of death. The group with cancer as a cause of death had the lowest incidence of major errors and fewer causes of deaths. To reduce major errors, continuous education and feedback are needed for those who are qualified to issue a death certificate.

Does the Application of International Classification of Disease Codes for the Cause of Death on Death Certificates Reduce Garbage Codes?

INTRODUCTION

This study aimed to determine if applying International Classification of Diseases (ICD) disease codes directly as the cause of death (COD) on death certificates (DCs) instead of writing or typing the COD could reduce the use of garbage codes.

METHODS

Beginning in April of 2016, a documentation process change was made, retiring the process of hand-writing or typing the COD onto DCs to directly applying ICD disease codes that were registered during the patient's course of treatment. The DCs issued at the emergency department (ED) 1 year before (Pre-code group) and after (Code group) applying ICD disease codes directly on DCs was instituted were retrospectively analyzed. The occurrence of garbage codes along with other major and minor errors was compared between the two groups. The investigation and judgment of errors were performed by four emergency physicians.

RESULTS

The overall garbage code occurrence in the Code group (25%) was significantly lower than that in the Pre-code group (49%). Fewer garbage codes were used in the Code group with an average of .5 in the Pre-code group and .3 in the Code group. No significant difference was identified in major error occurrences except for in the garbage codes. Minor errors were more common in the Pre-code group than in the Code group.

CONCLUSION

The overall use of garbage codes on DCs could be reduced by changing the process by which physicians complete DCs, that is, the application of documenting ICD disease codes directly as the COD on DCs.

Unifying the death notification form: Recommendations by the Saudi Health Council task force

Objectives

Death reporting and certification forms are essential elements of a country's healthcare policies. KSA faces several challenges regarding death reporting and certification. This study aims to provide recommendations to unify death notifications in Saudi Arabia.

Methods

In 2019, the General Secretariat of the Saudi Health Council designed a qualitative research project that aimed to provide recommendations to unify death notifications. The council convened a task force of physicians and healthcare administrators to design and conduct qualitative research to review the Saudi Health Council's policies related to death certification and investigate potential methods of improvement. In addition, the task force performed an extensive review of the literature and current practices in KSA.

Results

The task force proposed a set of robust recommendations to correct the issues affecting the current systems of death reporting and certification.

Conclusions

This report presents the working methodology and recommendations of the task force.

Common errors in reporting cause-of-death statement on death certificates: A systematic review and meta-analysis

The prevalence of death certificate (DC) completion errors is a universal issue. This research aimed to estimate the global prevalence of DC errors by performing a systematic review and meta-analysis. Databases including Web of Science, PubMed, Science Direct, Scopus, and Google search engine were searched by September 4, 2020. Thirty-five articles were included in the final analysis. The exact Clopper-Pearson confidence intervals, heterogeneity assessment, random effects models with Mantel-Haenszel methods were employed using STATA version 14.2 software. Absence of time interval (80.9%), absence/inappropriateness of comorbidities (45.1%), incorrect underlying cause-of-death (COD) statement (38.9%), improper sequence (36.2%), mechanism of death with underlying COD (UCOD) (33.6%), abbreviations (33.0%), mechanism only (23.9%), competing causes (21.5%), two or more condition per line (19.3%), incorrect COD (18.0%), nonspecific or ill-defined condition (16.4%), blanks/repetitive phrases (12.5%), and illegible handwriting (11.6%) were the most prevalent errors, respectively. Lack of or poor training/educating of certifiers, lack of physician understandings about the importance of DC and absence of quality assurance mechanisms were identified as the most significant causes of DC errors. Furthermore, providing ongoing, targeted and interactive training/education, and establishment of quality control and tracking mechanisms for completion of deficient DCs were suggested as the important improving solutions.

Death certification status in Eastern Mediterranean Region: A systematic review

A death certificate is an important public health surveillance tool that affects the quality of morbidity and mortality statistics. This systematic review examines death certification in the Eastern Mediterranean Region, uncovers the methodological qualities of published studies, the common errors committed by certifiers, and physicians' knowledge in filling out death certificates. We searched three databases, finding 19 studies, the majority of which reported errors in the underlying cause of death. Fewer than 25% of physicians reported training on filling out death certificates. Complexity of the cases and lack of training were reported as common difficulties facing physicians leading to errors.