Lakkireddy Dhanunjaya R, Gowda Manohar S, Murray Caroline W, Basarakodu Krishnamohan R, Vacek James L
St. Luke's Hospital--University of Missouri Kansas City School of Medicine, Kansas City, Kansas, USA.
Am J Med. 2004 Oct 1;117(7):492-8. doi: 10.1016/j.amjmed.2004.04.018.
To determine the ability of residents in completing death certificates correctly.
A total of 4800 residents were asked to complete a survey and cause-of-death statement using a sample case of in-hospital death due to urosepsis, of whom 590 residents (12%) responded. A scoring scale designed based on instructions from the National Association of Medical Examiners and the American College of Pathologists was used to measure responses quantitatively.
Overall performance was poor, with only 23% (n = 137) of responses in the optimal scoring range. The average score was influenced significantly by level of residency training, as well as previous experience, prior formal training, and awareness of the guidelines regarding death certificate completion. Optimal scores correlated with level of residency training and prior formal training in death certificate completion, suggesting the benefits of experience and instruction. Forty-five percent (n = 267) of respondents incorrectly identified a cardiovascular event as the primary cause of death.
The residents in this study demonstrated suboptimal performance in death certificate completion. Cardiovascular events were often incorrectly identified as the primary cause of death. Formal training can improve performance and should be emphasized in medical schools and residencies.
确定住院医师正确填写死亡证明的能力。
共4800名住院医师被要求使用一例因尿脓毒症导致的院内死亡样本病例完成一项调查及死因声明，其中590名住院医师（12%）做出了回应。采用基于美国国家法医协会和美国病理学家学会的指导方针设计的评分量表对回答进行定量测量。
总体表现较差，只有23%（n = 137）的回答处于最佳评分范围内。平均得分受到住院医师培训水平、既往经验、先前的正规培训以及对死亡证明填写指南的知晓程度的显著影响。最佳分数与住院医师培训水平以及先前在死亡证明填写方面的正规培训相关，表明经验和指导的益处。45%（n = 267）的受访者错误地将心血管事件认定为主要死因。
本研究中的住院医师在死亡证明填写方面表现欠佳。心血管事件常被错误地认定为主要死因。正规培训可提高表现，应在医学院校和住院医师培训中予以强调。
