An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any disease or injury that may be present for research or educational purposes.
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Introduction Accurate cause-of-death reporting is required for mortality data to validly inform public health programming and evaluation. Research demonstrates overreporting of heart disease on New York City death certificates. We describe changes in reported causes of death following a New York City health department training conducted in 2009 to improve accuracy of cause-of-death reporting at 8 hospitals. The objective of our study was to assess the degree to which death certificates citing heart disease as cause of death agreed with hospital discharge data and the degree to which training improved accuracy of reporting. Methods We analyzed 74,373 death certificates for 2008 through 2010 that were linked with hospital discharge records for New York City inpatient deaths and calculated the proportion of discordant deaths, that is, death certificates reporting an underlying cause of heart disease with no corresponding discharge record diagnosis. We also summarized top principal diag...
Mortality statistics, derived from death certificates, summarize population disease burden, inform research and program evaluations, and help determine public health priorities (1,2). Inaccurate cause-of-death reporting may result in misinformed policies, programs, and research (3–5). Previous studies found low levels of agreement between the death certificate cause of death and the sequence of events reported on the medical record (2,6,7). One possible reason for this disagreement is inadequate training of health care providers in death certification (8,9). Clinicians throughout the United States overreport heart disease as a cause of death and do so to a greater degree in New York City. A 2001 study of 4 US cities found that medical records did not substantiate 20% of death certificates that reported heart disease as an underlying cause of death (10), whereas a similar 2003 New York City study found an average discrepancy of 33% (11). Training can improve the accuracy of cause-of-...
Our analysis included the 8 intervention hospitals targeted in the 2009 New York City DOHMH training intervention. These hospitals had among the highest ratios of reported heart disease deaths to total deaths (16). Nonintervention hospitals included the 50 remaining hospitals reporting inpatient deaths in 2009. Additional characteristics of intervention and nonintervention hospitals have been described previously (11,16,18). For our analysis, we defined “preintervention” as the period from Ja...
Data sources and key variables
Death certificates and cause of death.The New York City Health Code mandates complete and accurate reporting of all deaths that occur in the city (20). The death certificate contains detailed information about the decedent as well as the circumstances and causes of death. Information about immediate, intermediate, underlying, and contributing causes of death are solicited from clinicians in conformance with the 2003 US Standard Certificate of Death (21). The National Center for Health Statist...
The focus of our study was agreement between the underlying cause of death reported on the death certificate and the principal and other diagnoses listed on the hospital discharge record. We defined a discordant record as one in which the death certificate reported an ICD-10 underlying cause of death of heart disease and the SPARCS record had no corresponding ICD-9-CM diagnosis for heart disease. We calculated the proportion of discordant records by year and intervention hospital status and t...
Heart disease mortality and discordant reports of heart disease deaths
Heart disease was the reported underlying cause of death on 39.1% (n = 21,192) of all New York City death certificates in 2008, 38.0% (n = 20,086) in 2009, and 34.1% (n = 17,929) in 2010 (Table). The proportion of inpatient death certificates reporting heart disease declined from 29.3% (n = 8,334) in 2008 to 28.1% (n = 7,573) in 2009 and 21.5% (n = 5,607) in 2010. Proportions were similar among deaths matched to a SPARCS record: 28.8% (n = 7,373) in 2008, 27.8% (n = 6,846) in 2009, and 21.4%...
Principal diagnoses among discordant reports
The top 5 disease classes reported on death certificates were infectious and parasitic diseases (42.3%; n = 464); respiratory diseases (16.0%; n = 175); circulatory diseases (9.6%; n = 105); digestive diseases (7.3%; n = 80); and neoplasms (6.0%; n = 66). The overrepresentation of infectious and parasitic diseases among discordant cases prompted post hoc analyses of this class. The top principal diagnosis among discordant reports was sepsis, a condition classified within infectious and parasi...
To our knowledge, ours is the first study to use hospital discharge data linked to death certificates to demonstrate the effect of training on cause-of-death reporting practices. Agreement between reporting of heart disease as an underlying cause of death and a diagnosis on the corresponding SPARCS record increased after a 2009 cause-of-death training intervention at New York City hospitals. The improvement was substantial at intervention hospitals; agreement increased 11.3%, from 79.8% in 2008 to 91.1% in 2010. Citywide, agreement increased 5.3 percentage points from 85.1% in 2008 to 90.4% in 2010. If we assume hospital discharge records are a reasonable proxy for the medical record, these results suggest the training improved the accuracy of cause-of-death reporting, which we could not conclude from the observed decline in heart disease deaths alone. The 2.0 percentage point change in agreement at nonintervention hospitals from 88.2% in 2008 to 90.2% in 2010 was also significant,...
Paulina Ong completed this project with support from the New York City Bureau of Vital Statistics through the Epi Scholars program at the New York City Department of Health and Mental Hygiene. Top
Corresponding Author: Ann Madsen, PhD, MPH, New York City Department of Health and Mental Hygiene, 125 Worth St, Room 203B, New York, NY 10013. Telephone: 646- 632-6724. E-mail: email@example.com. Author Affiliations: Paulina Ong, Melissa Gambatese, Elizabeth Begier, Regina Zimmerman, Antonio Soto, Ann Madsen, New York City Department of Health and Mental Hygiene, New York, New York. TopKircher T, Anderson RE. Cause of death: proper completion of the death certificate. JAMA 1987;258(3):349–52. CrossRefexternal icon PubMedexternal iconLloyd-Jones DM, Martin DO, Larson MG, Levy D. Accuracy of death certificates for coding coronary heart disease as the cause of death. Ann Intern Med 1998;129(12):1020–6. CrossRefexternal icon PubMe...Johansson LA, Westerling R. Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics. Int J Epidemiol 2000;29(3):495–502. CrossRefexternal icon Pu...Johns LE, Madsen AM, Maduro G, Zimmerman R, Konty K, Begier E. A case study of the impact of inaccurate cause-of-death reporting on health disparity tracking: New York City premature cardiovascular...
a Calculated as a percentage of matched New York City inpatient death certificates reporting heart disease as an underlying cause of death b Calculated as a percentage of matched New York City inpatient death certificates reporting heart disease as the underlying cause at intervention hospitals c Calculated as a percentage of matched New York City inpatient death certificates reporting heart disease as the underlying cause at nonintervention hospitals d The change in proportion of matched inpatient records with no mention of heart disease on the discharge record between 2008 and 2010 was statistically significant at P = .01. P values were calculated using a 2-tailed ztest for proportions. Top
- Paulina Ong, Melissa Gambatese, Elizabeth Begier, Regina Zimmerman, Antonio Soto, Ann Madsen
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Craig et al determined that cancer was the cause of death in 56.6% of 297 GR presenting for necropsy between 1985 and 1999; and this was more than German shepherds, Labrador retrievers, or ...
necropsy; death certification; There are written guidelines in each book of medical certificates of the cause of death (form 66) 1 that assist doctors in deciding when to refer a death to the coroner for further investigation. The largest single group of deaths reported is those in which the cause of death is unknown.
- I S D Roberts, L M Gorodkin, E W Benbow
Sep 11, 1999 · The registrar must report deaths of unnatural or unknown cause to the coroner, who has to hold an inquest where there is reason to suspect “a violent or an unnatural death” or “a sudden death the cause of which is unknown.” 2-16 A coroner is able to order a postmortem examination if he has reason to believe that a natural cause may be ...
The necropsy literature defines “major errors” as clinically missed diagnoses involving a principal underlying disease or primary cause of death. 6, 12 Class I errors are defined as clinically missed diagnoses which, if detected during life, “would”, “could”, possibly” or “might” have affected patient prognosis or outcome—at ...