@2024 Afarand., IRAN

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ISSN: 1027-1457    Scientific Journal of Forensic Medicine 2020;26(1):19-29

Background
Death information is an essential source of health system planning.
Previous Studies
... [1, 2]. The most important source of death information is hospitals, where most of the country's death information (more than 60%) is extracted [3]. The four factors, including the person issuing the death certificate, the items in the death certificate, the deceased, and the cause of death are involved in the process of documenting the death certificate [4]. ... [5, 19].
Aim(s)
The aim of the present study was to examine the documentation status of death certificates in the surgical intensive care unit of selected teaching hospitals of Mashhad University of Medical Sciences and provide solutions to improve it conducted in 2018-19.
Research type
This study was an applied research conducted by combining quantitative and qualitative methods in four stages.
Research society, place and time
None to declare.
Sampling method and number
None to declare.
Used devices&materials
At first, the death certificate checklist was made by reviewing the relevant literature and its validity and reliability were assessed. The death certificates issued in the surgical intensive care unit of selected hospitals were then examined. In the third phase, in the focus group sessions, people responsible for documentation were asked to document the causes of the defect. Finally, the results were presented to a panel of experts to find the most appropriate solutions. The relationship between the two quantitative variables was assessed using the Spearman correlation coefficient and the relationship between a quantitative variable and a qualitative variable was assessed using the Mann-Whitney and Kruskal-Wallis tests.
Findings by Text
56% of cases were male and 44% were female. The mean age of the deceased cases was 63.77±17.83 years and the mean number of hospitalization was 1.66 ±1.42 times. Also, the average hospital stay was 15.28 ±28.25 days. In 93% of the dead cases, a history of previous illness was recorded in the file. Fifteen research-related articles were thoroughly reviewed out of 76 articles (19.7%) retrieved from databases. After reviewing the texts of the above articles, 18 items related to error were identified, most of which referred to the items of lack of proper sequence, lack of proper underlying cause, and use of abbreviations (Table 1).According to the results of the examination of the forms, in none of the forms, the data related to the deceased were not fully recorded. In the general information section of the deceased, the items of the identity card number, the place of issuance of the identity card, the job and the status of the deceased's literacy were not usually recorded, and the rest of the cases were mostly completed. The signature of the physician completing the death certificate was present in 93.1% and the physician stamp was present in 97.5% of records. The physician issuing the death certificate was a resident (general anesthesia and surgery) in 93.6% of cases. The erasure rate was 4.9% in the diagnostic section and 9.3% in the other parts of the death certificate. Unreadability was observed in the demographic information of the deceased was 27.5%, in the information on the causes of death was 32.8%, and in the information related to the people responsible for documentation of the death certificate was 10.3%. None of the death certificates examined had completed the column related to the time between the onset of the disease and death. The language of diagnosis was Persian in 52% of cases, English in 2.9%, and a combination of Persian and English in 42.6% of cases. In 31.9% of cases, abbreviations were used instead of complete diagnosis in recording diagnoses. Also, according to the results of the study, the cause of direct death recorded in 21.1% and the cause of underlying death recorded in 26% in the death certificate did not match the items listed in the deceased file. There was an unacceptable sequence between the last line and the lines above in 55.4%. In 25% of cases, there was more than one sequence in the first part of the cause of death. The mean score of direct cause error was 49.00±65.92 and the underlying cause error was 40.50±26.13. The most important direct cause of death error was the recording symptoms and poorly defined conditions (81.4%), including cardio-respiratory arrest (45%), multiple organ failure (25%), and bradycardia-hypotension (7%). Also, the most common causes of intermediate causes were symptoms and poorly defined signs and conditions (71.7%), including sepsis (25%), peritonitis (10%), renal failure, heart failure (10%), pulmonary embolism (5%), treatment-resistant bradycardia (5%), impaired consciousness (5%), pulmonary edema (3%), intestinal obstruction (3%) and others (ascites, aspiration, pleural effusion) (3%). The most common cause of death was recording diagnoses with general and ambiguous terms (33.3%), the most important of which were pelvic fractures, multiple trauma (7%), heart disease and hypertension, heart failure (6%), peritonitis (5%), sepsis (4%), obstruction (4%), and abdominal mass, kidney mass, and pelvic mass (3%). The second cause of death was not recorded in more than 94% of death certificates (Table 2).Regarding the relationship between the percentage of errors related to causes of death and other information recorded in the death certificate, there was a significant relationship between the number of errors in the direct cause of death and the specialty of the physician issuing the death certificate (p = 0.035). Errors in recording the direct cause of death in physicians who specialize in intensive care were significantly lower than in residents. There was also a significant correlation between the error in recording intermediate causes with the age of the deceased (p = 0.005). Errors in recording intermediate causes increased significantly with age. Regarding other cases, such as general characteristics of the deceased, the number of hospitalizations, and the number of hospitalization days, manner, and time of death, no significant difference was observed. The kappa coefficient between the underlying cause recorded in the death certificate and the underlying cause recorded in the death system was 0.59, which statistically indicates the average agreement. The findings of the third phase of the study included the main reasons and problems mentioned by people involved in the death certificate registration process that was agreed upon by more than 75% of people (Table 3).In the fourth step, the death certificate and the death certificate system were examined as the main items, and practical solutions for each were proposed.
Main comparison to the similar studies
... [20-22]. In the present study, in 31.9% of cases, abbreviations were used to record diagnoses. In Meraji and Barabadi study, the use of abbreviations in recording the causes of death was 68% and in the study by Keyvanara et al., the use of abbreviations in educational centers was 34.8% and in non-educational centers was 43.7% [20, 23]. In the study by Nojilana et al., this rate was 10.3% and in a study by Ben Khalil et al., it was 63% [5, 21]. ... [22, 34].
Suggestions
A comparison of causes of death listed in corpse referral forms in hospitals with causes of death diagnosed in forensic medicine is suggested.
Limitations
One of the limitations of this research was studying only the files recorded in 2017.
Conclusions
Documentation status of death certificates in the surgical intensive care unit of selected hospitals is not desirable. Applying the strategies of this study can lead to a reduction in ineffective referral to forensic medicine and more accurate completion of the death certificate in areas, such as surgical intensive care unit of hospitals, and the possibility of providing accurate and complete statistics for better policy-making in the health system.
Acknowledgments
This article was extracted from a Master's thesis approved by the Mashhad University of Medical Sciences (971287), which was supported by the Mashhad University of Medical Sciences.
Conflict of interest
None to declare.
Ethical Permissions
This study was approved (IR.MUMS.REC.1397.286) by the ethics committee of Mashhad University of Medical Sciences.
Funding Sources
This study was financially supported by the Mashhad University of Medical Sciences.

TABLES and CHARTS

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