@2024 Afarand., IRAN

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ISSN: 1027-1457    Scientific Journal of Forensic Medicine 2020;26(3):169-172

Background
According to the causes of death in the death certificates issued by doctors, a significant portion of death statistics is issued by doctors [1].
Previous Studies
…[2-4]. The same definitions and formats should be used to compare death statistics globally and internationally [5]. In this regard, the World Health Organization (WHO), in the tenth edition of the International Classification of Diseases [6], has proposed a standard death certificate for universal use and provides instructions for completing the death certificate correctly, selecting the cause of death and its coding. ...[7-10]. Studies indicate a low quality of registration of death certificates in Iran [1, 2, 6, 11]. What can be seen in these studies is that many death certificates have no data value and validity [12].
Aim(s)
This study aimed to assess the compliance of the death certificate issued according to the standard of the World Health Organization and ICD-10 codes, the examination of the consistency level of the death causes recorded in the death certificate, which is the basis of statistical reports, with the real causes of death recorded in the medical records of patients and providing the solutions for potential problems in the death registration system in the country.
Research type
This study is an applied-descriptive study.
Research society, place and time
This study examined the death documents registered in the first six months of 2018 in 5 wards of ICU1, ICU2, ICU3, internal and infectious of Amir Al-Momenin Hospital in Zabol.
Sampling method and number
Three hundred eighteen cases were selected from the total number of deaths recorded (n=390) in the death certificate booklet of the five mentioned sections randomly, registered by specialists in internal medicine, infectious diseases, general surgery, neurology, cardiology, pulmonary, and chest surgery. It should be noted that the death certificates registered by the forensic specialist and poisoning were not included in the study according to the purpose of the study and the compliance of the diagnoses with the ICD-10 book.
Used devices&materials
The cause of death was investigated using the issued death certificate forms, and the way of its completion was compared with the rules listed according to the ICD-10 criteria [6] and the rules listed on the booklet and the back of the death certificate. The causes of death were classified into correctly registered code and empty code (includes writing in English letters, using medical abbreviations without explanation, cardiac and respiratory arrest, and errors in writing the death board). Data were analyzed after coding using SPSS 18 software.
Findings by Text
According to the findings, 313 certificates (98.4%) had blank codes, and only five certificates (1.6%) were completed correctly. The highest number of certificates with null code was related to the ICU1 ward with 120 certificates, and the lowest number was related to the infectious ward with 12 death certificates (Table 1).The physicians who completed the death certificates were from 7 specialized and sub-specialized fields (internal medicine, infectious diseases, general surgery, neurology, heart, pulmonary, and chest). The highest number of death certificates with null code was completed by general surgeons with 127 certificates (39.9%), and the lowest number of certificates was completed by pulmonary specialists with three certificates (0.9%) (Table 1). The highest frequency of blank codes in the examined certificates was related to writing in English letters, medical abbreviations without explanation and cardiac arrest. Also, the most common types of errors leading to null code are related to writing in English letters in the infectious (41.7%), ICU2 (43.3), ICU3 (46.3), and internal (50%) and cardiopulmonary arrest sections. Were in ICU1 (22.2%). The highest number of null codes reported by internal medicine, infectious disease, and general surgery specialists were related to English letters with 45.3%, 33.3%, and 39.4%, respectively. The highest number of null codes reported by neurologists, the heart specialist was related to unexplained medical abbreviations (65%) and cardio-respiratory arrest and writing in English letters (33.3%), respectively. This rate in pulmonary and chest specialists was related to the errors in writing the death board with the frequency of 1% and 58.3%, respectively (Table 1).
Main comparison to the similar studies
More than 98% of death certificates issued in Amir Al-Momenin (AS) Hospital in Zabol had a null code which was consistent with the study of Haghighi et al. [7] entitled, the accuracy of coding the cause of death in Bandar Abbas teaching hospitals, and the study of Keyvanara et al. [2] entitled quality of registration of death certificates issued in educational and non-teaching hospitals in Kermanshah city.
Suggestions
The suggestions of this research include considering the method of completing the death certificate in the educational topics of medical and midwifery students, none use of abbreviations and write the cause of death in English, requiring treating physicians of the deceased in hospitals or training centers to issue a death certificate and Checking and confirming the death certificate issued and following up on the relevant deficiencies.
Limitations
The illegibility of some of the registered death certificates was a limitation of this study.
Conclusions
Death certificates registered by specialists in Amir Al-Momenin (AS) Hospital in Zabol are not at an acceptable level according to ICD-10 standards.
Acknowledgments
We are very grateful to all the Amir Al-Momenin Hospital staff in Zabol who have helped us in data collecting.
Conflict of interest
There is no conflict of interest.
Ethical Permissions
This article is retrieved from a research project approved by Zabol University of Medical Sciences with IR's ethical code.ZBMU.REC.1398.022.
Funding Sources
All financial resources required for this article have been provided by Zabol University of Medical Sciences.

TABLES and CHARTS

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