Mant Jonathan, Wilson Sue, Parry Jayne, Bridge Pam, Wilson Richard, Murdoch Will, Quirke Terry, Davies Michael, Gammage Michael, Harrison Rebecca, Warfield Adrian
Department of Primary Care and General Practice, Primary Care Clinical Sciences Building, University of Birmingham, Birmingham B15 2TT, United Kingdom.
J Clin Epidemiol. 2006 Aug;59(8):862-7. doi: 10.1016/j.jclinepi.2005.11.021. Epub 2006 May 23.
Routine statistics and epidemiologic studies often distinguish between types of cardiac death. Our aim was to assess agreement between doctors on cause of death given identical clinical information, and to assess agreement between a physician panel and the original cause of death as coded on national statistics.
Clinical information and autopsy reports on 400 cardiac deaths were randomly selected from a defined population in the West Midlands, UK. A panel of eight clinicians was assembled, and batches of 24-25 cases were sent to pairs of these clinicians who, blinded to the certified cause of death, independently of each other assigned underlying cause of death. Physician panel decision was achieved by consensus. Levels of agreement were assessed using the kappa statistic.
Reviewers agreed on cause of death in 54% of cases (kappa = 0.34). Consensus decision of reviewers agreed with death certificate diagnosis in 61.5% (kappa = 0.39). Agreement was higher if an autopsy had been performed (kappa = 0.49).
The process of identifying underlying cause of death is of limited reliability, and therefore, limited accuracy. This has implications for design of epidemiologic studies and clinical trials of cardiovascular disease.
常规统计和流行病学研究常常区分不同类型的心脏性死亡。我们的目的是评估在提供相同临床信息的情况下医生之间关于死因判定的一致性，以及评估一个医生小组与国家统计编码的原始死因之间的一致性。
从英国西米德兰兹郡特定人群中随机选取400例心脏性死亡的临床信息和尸检报告。组建了一个由8名临床医生组成的小组，将24 - 25例病例分成批次分别发送给这些临床医生两两一组，他们在对已认证的死因不知情的情况下，彼此独立地确定根本死因。医生小组的决定通过共识达成。使用kappa统计量评估一致性水平。
评审者在54%的病例中对死因达成一致（kappa = 0.34）。评审者的共识决定与死亡证明诊断在61.5%的病例中一致（kappa = 0.39）。如果进行了尸检，一致性更高（kappa = 0.49）。
确定根本死因的过程可靠性有限，因此准确性也有限。这对心血管疾病的流行病学研究和临床试验设计具有影响。
