ARTICLE INFO

Article Type

Descriptive & Survey Study

Authors

Yousefinejad   V. (1)
Sohrabi   M. (*2 )
Mohammadzadeh   P. (2)






(*2 ) Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
(1) Liver & Digestive Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
(2) Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran

Correspondence

Address: Student Research Committee, Kurdusran University of Medical Sciences, Sanandaj, Iran
Phone: +98-87-33247855
Fax:
mhsn.sohrabi@gmail.com

Article History

Received:  August  7, 2018
Accepted:  October 23, 2018
ePublished:  December 20, 2018

BRIEF TEXT


ICD-10 Principles

… [1-6]. To comparison of the mortality information at the international level, the standard and uniform definitions and templates should be used. Hence the world health organization (WHO) have been proposed two standard death certifications for use in different countries in the second volume, and the tenth edition of the International Classification of Diseases (ICD-10)(7). …[8-9]. In the study of Rezvani et al. the level of general coordination between the direct causes of death recorded in medical records and death certificates was 68% and the rate of general coordination between the basic causes of death recorded in the medical records was 64% which is classified at a good level, statistically (10).

The present study aimed to investigate the accuracy of the causes of death recorded in the death certificates issued from the Sanandaj university hospitals based on the ICD-10 principles.

This research is a descriptive-analytical study.

This study was conducted by refer to the archives of the Tohid and Besat hospitals in Sanandaj city through study of 1506 death certificates from the late September 2015 to the September 2017.

After confirmation by the research council of Kurdistan University of Medical Sciences and obtaining a license, the death certificates of the Besat and Tohid hospitals in Sanandaj in late September 2015 to the September 2017 was extracted. Exclusion criteria of the study consisted of lack of access to the records and non-issuance of burial license in the hospital because of corps referral to the legal medicine. In total, 1506 death certificates were investigated.

Data collection was conducted by a checklist including file number, age, gender, season, hospital, hospitalization section, the direct and basic cause of death recorded in the death certificate based on the standard of ICD-10 and type of specialty of doctor who issued a death certificate. After completing the checklists, the files were referred to the specialist of legal medicine to investigating the accuracy of the recorded causes of death compared with the principles of ICD-10 recorded by the medical records system. The scoring was done in the three options of correct, wrong and incomplete. The frequency of true causes of death was calculated based on the variables. Data were analyzed by SPSS 18 software through descriptive statics, Chi-square, independent T and one-way analysis of variance tests.

Of 1506 death certificates, 743 cases were from the Tohid hospital and 763 cases were from the Besat hospital. The average age of mortality in the Tohid and Besat hospitals was 65.10±17.49 and 30.41±22.48 respectively. Considering the principles of ICD-10, most of the death certificates with recording the wrong causes related to the average age of 29.68±2.81. There was a significant relationship between the age of death and the accuracy of determining the cause of death (p<0.05). In total, 905 death cases related to males (60.1%) and 601 death cases related to females (39.9%). The wrong and null codes in the decedent man were 37.3%, 2.4% and in the decedent females were 33.1%, 1.2%, respectively. The determined most common true cause of death in males related to the cardiovascular disease (35.8%), accidents (7.3%), respiratory diseases (5.15), and cancers (2.9%) and in females related to cardiovascular disease (42.6%), respiratory diseases (5.0%), accidents (4.2%), and cancers (4.0%). In total, cardiovascular disease (72.5%), accidents (10.0%), respiratory diseases (4.4%) and cancers (3.0%) had the most frequent. There was a significant relationship between gender and the accuracy of determined causes of death based on the principles of ICD-10 (p>0.04). The prevalence of death because of cardiovascular disease, cancers, blood diseases, congenital anomalies was higher in females and prenatal, infectious, respiratory and gastrointestinal diseases, external factors and accidents were higher in males. There was a significant difference between the hospital and accuracy of determining the cause of death based on the principles of ICD-10 (p>0.0001) so that the scores of wrong and null codes in the Besat hospital was 69.7% and 1.3% and in the Tohid hospital was 7& and 2.6%, respectively (Table 1). The departments of the Besat hospital were included of the departments of children, women, neurosurgery, orthopedic, general surgery and urgency and the departments of the Tohid hospital was included of the departments of internal organs, eye, ear, digestion, hearth, infectious, neurological, urological, ear nose and throat (ENT) and eye. There was a significant relationship between the accuracy of causes of death based on the principles of ICD-10 with the doctor who issued the death certificate (p<0.0001), so that the higher rate of errors in determining the causes of death was related to the pediatricians (34.1%), neurosurgery specialists (25.3%), resident doctor (12.8%), general surgeon (6.1%), gynecologists (5.1%), and emergency medicine (4.1%) and the minimum rate of errors was related to the specialists of legal medicine with a relative frequency of 3.4%.

In this study, the higher rate of error was related to the Besat hospital (71.0% of the determined causes of death resulted to the wrong and null codify), while in the Tohid hospital this rate is 3.3%. Mostafazadeh et al. in a study showed that the codes of ICD-10 have been completed in the 93.7% cases of death certificates and in 64.8% of cases, the codes were correctly listed which in comparing with the present study, the Tohid hospital had a more favorable situation and the Besat hospital had an unfavorable situation (110). In this study, the minimum rate of error in determining the causes of death was related to the specialists of legal medicine with 3.4% and the maximum rate of error was related to the pediatricians and neurosurgery specialist that was in accordance to the study of Mostafazadeh et al, which determined the error of specialists of legal medicine by 15.5% (11)…[12-15].

It is suggested that in the future, studies be planned to examine the mortality data and the accuracy of records in all death cases in the province based on the principles of ICD-10.

One of the limitations of this study was the exit of some samples from the study because of corpse referral to the legal medicine and determining the cause of death in legal medicine

The accuracy rate of recorded causes of death by doctors was in the low level in the Tohid and Besat hospitals based on the principles of ICD-10 which showed the incorrect determination of causes of death in death certificates by doctors in the hospitals.

The authors of the article express their appreciation to all staff of the archive of the Besat and Tohid hospitals in Sanandaj city for their cooperation.

There is no conflict of interest.

The present study with a code of IR.MUK.REC.1396/290 was confirmed by the ethics committee in research council of Kurdistan University of Medical Sciences

This study was funded by the research and technology deputy of Kurdistan University of Medical Sciences.

TABLES and CHARTS

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CITIATION LINKS

[1]Saraei H. Primary population analysis methods (with emphasis on fertility and mortality). 4th Edition. Tehran: University of Tehran; 2008. [Persian]
[2]Heron M. Deaths: leading causes for 2012. Natl Vital Stat Rep. 2015;64(10):1-93
[3]Saukko P, Knight B. Knight’s forensic pathology. 3rd Edition. Boca Raton, Florida: CRC Press; 2004.
[4]Rodriguez MM, Bruce JH, Jimenez XF, Romaguera RL, Bancalari E, Garcia OL, Ferrer PL. Nonimmune hydrops fetalis in the liveborn: series of 32 autopsies. Pediatr Dev Pathol. 2005;8(3):369-78.
[5]Sadooghi Z, Javaheri M, Sohrabian B, Poursafar A, Rezaei N. Examining the cause and five year trend of mortality rate from 2007 to 2011 in Ilam province, Iran. Health Syst Res. 2016;12(3):375-80. [Persian]
[6]Yavari P, Abadi A, Mehrabi Y. Mortality and changing epidemiological trends in Iran during 1979-2001. Hakim Res J. 2003;6(3):7-14. [Persian]
[7]Ghadipasha M, Khodabandeh F, Najari F, Tabaghchi Ezati M. A comparison between autopsy reported & clinical cause of death on the basis of specialty in cadavers referred to Kahrizak Legal Medicine Center in 2012. Scientific J Forensic Med. 2016;22(3):219-27. [Persian]
[8]Aghamohammadi S, Kazemi E, Khosravi A, Kazemeini H. The trend of ten leading causes of death in the Islamic Republic of Iran, 2006- 2011. Iranian J Epidemiol. 2017;12(4):1-11. [Persian]
[9]Mathers CD, Boerma T, Ma Fat D. Global and regional causes of death. Br Med Bull. 2009;92(1):7-32.
[10]Rezvani Ardestani SF, Shahnavazi H, Ghorbani M. Survey on the accuracy of death certificated issued with WHO standards & ICD10 mortality codes in Sina Hospital in Tehran in the second half of 2013. Scientific J Forensic Med. 2015;21(2):99-106. [Persian]
[11]Mostafazadeh B, Kamaloddini MH, Najari N. Study of death certificates and burial permit with the criteria of the world health organization and the ministry of health and medical education in Tehran during 2013-2014: brief report. Tehran Univ Med J. 2017;75(6):457-62. [Persian]
[12]Sadeghi Jebeli M, Africheh H, Mojdeh S, Saqaiannejad Esfahani S, Mehrabi A. Survey on consistency surface between the recorded causes of death in death certificate and the recorded causes of death in medical record for cardiovascular patient in the educational hospitals of Isfahan. Scientific J Forensic Med. 2010;16(1):21-7. [Persian]
[13]McGivern L, Shulman L, Carney JK, Shapiro S, Bundock E. Death certification errors and the effect on mortality statistics. Public Health Rep. 2017;132(6):669-75.
[14]Jahani M, Eskandari F, Mahmoudjanloo Sh, Mahmoudi Gh. The causes of the mortality of inpatients in the hospitals covered by Semnan province universities of medical sciences based on ICD10. J Healthc Manag. 2017;8(3):7-16. [Persian]
[15]World Health Organization. The top 10 causes of death [Internet]. Geneva: World Health Organization; 2018 [cited 2018 Aug 6]. Available from: http://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.