Illing Georg, Lessig Rüdiger, Stang Andreas
Klinik für Innere Medizin II, HELIOS Klinikum Aue, Aue.
Institut für Rechtsmedizin, Martin-Luther-Universitat Halle-Wittenberg, Halle.
Gesundheitswesen. 2020 Apr;82(4):354-360. doi: 10.1055/a-0820-3452. Epub 2019 Jan 21.
Postmortem examination as the last service of physicians has been increasingly criticized recently. The aim of this project was to study the influence of place of death, type of postmortem physician, age and sex of the deceased person on the completeness and quality of ICD-10 coding of death certificates issued by physicians in Chemnitz, Germany.
We reviewed 15 612 death certificates and 353 autopsy reports of the health office of Chemnitz for the years 2010-2013. We extracted age and sex of the deceased, causes of death as based on the primary postmortem examination and after autopsy if applicable, type of death (natural or unnatural cause of death), and complications as discovered at the second postmortem examination before cremation. In addition, we documented the place of death and type of physician carrying out the postmortem examination. Furthermore, we corrected the inappropriate or missing ICD-10 codes followed by agreement analysis. The analysis was in agreement with the rules of the German Institute of Medical Documentation and Information.
The autopsy rate was 2.3%. The underlying condition was not documented in 34.1% of the cases. The agreement between quality-controlled ICD-10 coding of the cause of death and the original ICD-10 coding (three-digit codes) was high (96.5%). High age at death, death not occurring in hospitals, and postmortem examination not carried out in hospitals were associated with a higher probability of ICD-10 miscoding. The observed agreement of 3-digit ICD-10 coded underlying condition after primary postmortem examination and after autopsy was 26.3%. The underlying cause of death contained garbage codes in 24.2%, that is, codes that are inappropriate for cause of death statistics.
Physicians have to be sensitized to the need for appropriate documentation of causes of death. Autopsy very frequently resulted in a change of the assessment of the underlying cause of death and therefore remains an important quality control measure for certification on the cause of death. ICD-10 coding of causes of death is not a primary task of physicians and physicians should not be required by law to carry out this task.
尸体解剖作为医生的最后一项服务，近年来越来越受到批评。本项目的目的是研究死亡地点、尸体解剖医生类型、死者年龄和性别对德国开姆尼茨医生出具的死亡证明ICD - 10编码的完整性和质量的影响。
我们回顾了开姆尼茨卫生局2010 - 2013年的15612份死亡证明和353份尸检报告。我们提取了死者的年龄和性别、基于初次尸体解剖以及适用时尸检后的死因、死亡类型（自然或非自然死亡原因）以及火化前二次尸体解剖发现的并发症。此外，我们记录了死亡地点和进行尸体解剖的医生类型。此外，我们纠正了不适当或缺失的ICD - 10编码，随后进行一致性分析。该分析符合德国医学文献与信息研究所的规则。
尸检率为2.3%。34.1%的病例未记录潜在病因。死因的质量控制ICD - 10编码与原始ICD - 10编码（三位编码）之间的一致性很高（96.5%）。高死亡年龄、非在医院死亡以及非在医院进行尸体解剖与ICD - 10编码错误的可能性较高相关。初次尸体解剖后和尸检后观察到的三位ICD - 10编码潜在病因的一致性为26.3%。死亡的根本原因包含垃圾编码的比例为24.2%，即不适用于死因统计的编码。
必须提高医生对适当记录死因必要性的认识。尸检经常导致对根本死因评估的改变，因此仍然是死因认证的一项重要质量控制措施。死因的ICD - 10编码不是医生的主要任务，法律不应要求医生执行此任务。
