Mushtaq F, Ritchie D
Crosshouse Hospital, Kilmarnock, KA2 0BE, UK.
Emerg Med J. 2005 Oct;22(10):718-21. doi: 10.1136/emj.2004.018721.
To establish the discrepancy rate between the predicted cause of death and the actual cause of death as determined by postmortem examination result, for all deaths in the emergency department reported to the Scottish Procurator Fiscal and subsequently undergoing postmortem examination.
A prospective study of all patients who were dead on arrival or died in the emergency department of a busy Glasgow hospital over a 12 month period. The most senior emergency physician present at the time of death predicted the cause of death. This was then compared to the actual postmortem examination determined cause of death and was considered either to be correct or incorrect.
During the study period, 146 patients were pronounced dead in the department. Of these, 81 patients (age range 39-99 years, median 71; male:female 2.5:1) had death certificates issued, 63 patients (age range 26 days to 99 years, median 48; male:female 2.4:1) had a postmortem performed by the forensic pathologist, and two patients underwent a "view and grant". Of the 63 deaths reported to the Procurator Fiscal, the emergency physician attributed 51 (80.1%) to non-trauma, 9 (14.2%) to trauma, and in 3 (4.7%) cases were uncertain. Of the 63 (39.7%) deaths, 25 were inaccurately predicted (99% confidence interval 24.3% to 56.6%; p<0.0)1. Cardiovascular related and drugs poisoning deaths occurred most commonly. They were also the most accurately predicted cause of deaths. Intracranial events, pulmonary thromboembolism, and airway obstruction were also frequently predicted, but were often wrong.
This study highlights the difficulties in accurately identifying cause of death for patients who die suddenly. This could have implications for the accuracy of health service statistics.
确定向苏格兰地方检察官报告并随后接受尸检的急诊科所有死亡病例中,预测死因与尸检确定的实际死因之间的差异率。
对一家繁忙的格拉斯哥医院急诊科在12个月期间所有到达时已死亡或在急诊科死亡的患者进行前瞻性研究。死亡时在场的最高级急诊医师预测死因。然后将其与尸检确定的实际死因进行比较,并判断预测是正确还是错误。
在研究期间,有146名患者在该科室被宣布死亡。其中,81名患者(年龄范围39 - 99岁,中位数71岁;男女比例2.5:1)获得了死亡证明,63名患者(年龄范围26天至99岁,中位数48岁;男女比例2.4:1)由法医病理学家进行了尸检,2名患者接受了“查看与批准”。在向地方检察官报告的63例死亡病例中,急诊医师将51例(80.1%)归因于非创伤性原因,9例(14.2%)归因于创伤性原因,3例(4.7%)情况不确定。在63例(39.7%)死亡病例中,有25例预测不准确(99%置信区间24.3%至56.6%;p<0.01)。心血管相关和药物中毒死亡最为常见。它们也是预测最准确的死因。颅内事件、肺血栓栓塞和气道阻塞也经常被预测到,但往往预测错误。
本研究突出了准确识别猝死患者死因的困难。这可能对卫生服务统计的准确性产生影响。