Engel L W, Strauchen J A, Chiazze L, Heid M
Am J Epidemiol. 1980 Jan;111(1):99-112. doi: 10.1093/oxfordjournals.aje.a112879.
Accuracy of certification of underlying cause of death and implications for US mortality statistics were assessed among 257 autopsied cases collected during the calendar year 1970 at a short-stay general hospital in Atlanta, GA. Clinicopathologic cause of death (CPCD) certificates, with assignment of underlying cause of death based on autopsy findings in combination with pertinent clinical data, were prepared by a pathologist and were employed as a standard of comparison against which the accuracy of the underlying cause of death on the original death certificate was measured. Results suggest that autopsy findings are not necessarily used to supplement clinical data in filling out death certificates. Improper recording of underlying cause of death was found in 42% of the autopsied cases. Malignant neoplasms were found to be underreported and vascular diseases overreported, each by approximately 10%, when original certificates were compared to CPCD certificates. The confirmation rate for original death certificate diagnoses was 89%. In the case of a confirmed diagnosis, the underlying cause of death was substantiated by postmortem findings as having existed regardless of its role in the sequence of events leading to death. The underlying cause of death as assigned by the pathologist was listed on the original death certificate among the sequence of events leading to or contributing to death at the rate of 72% (i.e., this rate measures the sensitivity of the death certificate).
1970年日历年期间，在佐治亚州亚特兰大的一家短期综合医院收集了257例尸检病例，评估了死因根本原因认证的准确性及其对美国死亡率统计的影响。由病理学家根据尸检结果结合相关临床数据编制临床病理死因（CPCD）证书，并将其作为比较标准，用以衡量原始死亡证书上死因根本原因的准确性。结果表明，在填写死亡证书时，尸检结果不一定用于补充临床数据。在42%的尸检病例中发现了死因根本原因的记录不当。将原始证书与CPCD证书进行比较时，发现恶性肿瘤报告不足，血管疾病报告过多，各约为10%。原始死亡证书诊断的确认率为89%。在确诊的情况下，无论其在导致死亡的事件序列中的作用如何，死后检查结果都证实了死因根本原因的存在。病理学家指定的死因根本原因在原始死亡证书上列为导致或促成死亡的事件序列中的比例为72%（即，该比例衡量死亡证书的敏感性）。
