Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers

Abstract

ObjectiveTo systematically review the reliability of hospital data on cause of death and encourage periodic reviews of these data using a standard method.MethodsWe searched Google Scholar, Pubmed and Biblioteca Virtual de la Salud for articles in English, Spanish and Portuguese that reported validation studies of data on cause of death. We analysed the results of 199 studies that had used medical record reviews to validate the cause of death reported on death certificates or by the vital registration system.FindingsThe screened studies had been published between 1983 and 2013 and their results had been reported in English (n = 124), Portuguese (n = 25) or Spanish (n = 50). Only 29 of the studies met our inclusion criteria. Of these, 13 had examined cause of death patterns at the population level – with a view to correcting cause-specific mortality fractions – while the other 16 had been undertaken to identify discrepancies in the diagnosis for specific diseases before and after medical record review. Most of the selected studies reported substantial misdiagnosis of causes of death in hospitals. There was wide variation in study methodologies. Many studies did not describe the methods used in sufficient detail to be able to assess the reproducibility or comparability of their results.ConclusionThe assumption that causes of death are being accurately reported in hospitals is unfounded. To improve the reliability and usefulness of reported causes of death, national governments should do periodic medical record reviews to validate the quality of their hospital cause of death data, using a standard.

Review of errors in the issue of medical certificates of cause of death in a tertiary hospital in Ghana

“…1 In Ghana, the Registration of births and deaths Act of 1965 (Act 301) stipulates that the MCCD should be issued free of charge by the medical practitioner who was last in attendance during the illness of the deceased, and this certificate shall forthwith be delivered to the Registrar.…”

“…Such data should be specific, accurate and complete. 1,2 The WHO defined cause of death as "…the disease or injury which initiated the train of morbid events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury'. 1 There is the awareness that a chain of events culminates in death and the Medical Certificate of Cause of Death (MCCD) is designed to capture these events with nosologists placing emphasis on the one that initiated these events during capture of mortality data.…”

The paradox of verbal autopsy in cause of death assignment: symptom question unreliability but predictive accuracy

“…The careful selection of gold standard cases for the Mexican hospital study means that results represent an ideal rather than established practice. A recent systematic review of hospital COD statistics concluded that misdiagnosis in medical certificates of COD was the norm rather than the exception [23]. The primary motivation for introducing VAs into CRVS systems is to provide population-level mortality statistics – i.e., Cause Specific Mortality Fractions (CSMFs), and not to provide COD for individuals.…”

Hospital Mortality – a neglected but rich source of information supporting the transition to higher quality health systems in low and middle income countries

“…This will require better training for health workers who document diagnoses and cause of death in most routine settings [10]. Inadequate investments in information systems generally and in this area specifically are one reason why external assessments of the accuracy of hospital cause of death data in LMIC suggest it can be poor [11,12] and incomplete [13]. Illustrating this we display in Box 1 the frequency of missing data on hospital mortality from 272 public hospitals in Kenya [14], with data missing for an entire 12 months on surgical admissions and outcomes in over 200 hospitals.…”