Alfsen G Cecilie, Lyckander Lars Gustav
Department of Pathology, Akershus University Hospital, Norway.
Tidsskr Nor Laegeforen. 2013 Apr 9;133(7):750-5. doi: 10.4045/tidsskr.12.0943.
The effects of inaccurate death certificates on cause of death statistics are uncertain. Since 2008, Akershus University Hospital has systematically corrected all death certificates. The effects of these corrections on the total cause of death statistics from the hospital were studied.
ICD-10 codes for the underlying cause of death on the original and the corrected death certificates issued by Akershus University Hospital were retrieved from the Cause of Death Registry for the period 1 May 2008-31 December 2009, once the Cause of Death Registry had processed the death certificates with the aid of the computer program ACME (Automatic Classification of Medical Entities).
Altogether 1,001 deaths were investigated (547 men and 454 women). A total of 223 death certificates were corrected. This entailed changing the underlying cause of death in 176 cases. Death certificates for women were corrected most frequently. In 121 cases, the changes entailed a change of disease chapter in ICD-10. The corrections caused a significant reduction in the number of unspecific diagnoses, such as sepsis, cardiac arrest, pneumonia with no further specification, renal failure and fractures without any specific cause. There was a significant exchange of individuals within all the large diagnostic groups, with the exception of cancer. Because of the balancing effect of exchanges within and between the disease chapters, this generated only minor effects on general statistics on causes of death.
The continuous correction of death certificates in the hospital was important for adjustments at the individual level and as a quality control of cause of death statistics, but had only minor effects on the general statistics from the hospital.
死亡证明不准确对死因统计的影响尚不确定。自2008年以来，阿克什胡斯大学医院系统地纠正了所有死亡证明。本研究探讨了这些纠正措施对该医院总体死因统计的影响。
从死因登记处检索了2008年5月1日至2009年12月31日期间阿克什胡斯大学医院出具的原始和纠正后的死亡证明上的潜在死因的国际疾病分类第十版（ICD-10）编码，该期间死因登记处借助计算机程序ACME（医学实体自动分类）处理了死亡证明。
共调查了1001例死亡病例（男性547例，女性454例）。总共223份死亡证明得到纠正。这涉及到176例潜在死因的更改。女性的死亡证明更正最为频繁。在121例中，更改涉及ICD-10中疾病章节的改变。这些更正导致非特异性诊断的数量显著减少，如败血症、心脏骤停、未进一步明确的肺炎、肾衰竭和无特定原因的骨折。除癌症外，所有大型诊断组内都有个体的显著交换。由于疾病章节内和之间交换的平衡作用，这对总体死因统计仅产生了轻微影响。
医院持续纠正死亡证明对于个体层面的调整以及作为死因统计的质量控制很重要，但对医院的总体统计仅产生了轻微影响。
