Agenda
Overview of Death Certification and Cause of Death
Review of proposed DeCoDe process
Q & A / Discussion
Introduce case examples
Lunch Break
Facilitated discussion on assigning cause of death
Wrap-up and summary of discussion
1
ICD-10
International Statistical Classification of Diseases and Related Health
Problems- 10th Revision
• Purpose: to permit systematic
recording, analysis, interpretation
and comparison of mortality and
morbidity data collected in different
countries or areas and at different
times. The ICD is used to translate
diagnoses of diseases and other
health problems from words into an
alphanumeric code, which permits
easy storage, retrieval and analysis
of the data.
• Most routine statistical uses of the
ICD involve selection of a single
condition from a certificate or record
where more than one is entered
2
3
Leading causes 2015
% change #’s
% change rate
Global Burden of
Disease Study 2015
Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of
Disease Study 2015Lancet, Volume 388, Issue 10053, 2016, 1725–1774
Part I :Lines 1-4
Causes of death are
entered sequentially
starting with immediate
cause and ending with the
underlying cause
Part II
Other significant
conditions contributing
to death
5
2016 Version
6
Important definitions involving causes of death
• Cause of death: “all those diseases, morbid conditions or injuries which either
resulted in or contributed to death and the circumstances of the accident or
violence which produced any such injuries”. It does not include symptoms or
modes of dying (e.g. cardiac arrest) “
• Underlying cause: “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” If there is not a sequence of events, the
immediate (line I(a)) is also the underlying cause. This is the condition used as
the basis for official mortality statistics
• Multiple causes of death: causes of death including not only the underlying
cause but also immediate cause of death and all other intermediate and
contributory conditions entered by the certifying physician
• Mode of dying: the mechanism by which the death occurred, e.g. cardiac arrest
or respiratory failure, should not be reported as the immediate cause of death
• Manner of death: how the death came about- natural, accident, suicide,
homicide, undetermined and pending
7
Certifying a death
• Only one condition should be entered on each line, with the following exception.
In the unusual situation where two independent diseases are thought to have
contributed equally to the sequence at a particular point, they may be entered
on the same line.
• If the cause of death is unknown, even after investigation, it is correct to
document “unknown” or “cause of death not determined”. This is preferable to
speculating on a possible cause of death.
• In a violent or unnatural death, the injury resulting from external causes is the
immediate cause of death. The external cause of the injury is recorded as the
underlying cause.
8
ICD-10 rules for selection of the underlying cause of death
The General Principle
When more than one
condition is entered on the
death certificate, select the
condition entered alone in
the lowest-used line of Part
1 only if it could have given
rise to all the conditions
entered above it.
Immediate cause reported
on Part I(a) of certificate
YES
…is an acceptable cause of…
Immediate cause reported on
Part I (b) of certificate
YES
…is an acceptable cause of…
Immediate cause reported on
Part I (c) of certificate
YES
…is an acceptable cause of…
Tentative underlying cause
reported on Part I (d) of certificate
9
ICD-10 rules for selection of the underlying cause of death
The General Principle
When more than one condition is entered on the death certificate, select the
condition entered alone in the lowest-used line of Part 1 only if it could have given
rise to all the conditions entered above it.
Immediate cause reported
on Part I (c) of certificate
Immediate cause reported
on Part I(a) of certificate
Immediate cause reported
on Part I (b) of certificate
…is an acceptable cause of every
condition reported on lines above it
Tentative underlying cause
reported on Part I (d) of certificate
10
Medical Certifier and Automated Coding Systems for
Selecting Underlying Cause of Death
IRIS
11
Multiple Causes of Death
• Valuable supplement to underlying cause data
• By using only the underlying cause of death, valuable information is lost
• In the United States, about 75% of death certificates have more than one
condition listed, with the average about 3 conditions
12
Figure 4. CDAIsa—all causes under study as contributing cause of death—deaths at age 65 and
above, France and Italy, 2008.
Copyright © by SAGE Publications
Aline Désesquelles et al. J Aging Health 2014;26:283-315
Multiple Causes of Death
15
Source: V. Egidi, M.A. Salvatore and G. Rivellini “Studying casues of death interrelations by the Social Network Analysis”
CHAMPS DeCoDe Process
CHAMPS Data Package Submission Timeline
Mortality Surveillance
Protocol
Site(s)
Program
Office
Site Deliverables
0 7
30
55
CHAMPS PO Deliverables
Package 1 – Notification to
Consent
Screening– Report(s)
Package 2 – Raw TAC File
TAC– TAC Report(s)
Package 3 – All Site Case Data (less
DeCoDe)
Package 4 – Verbal Autopsy (less DeCoDe)
Case Data– Clinical & Lab Data Reports
Package 5 – CDC CPL Final Report
Package 6 – DeCoDe Results
17
VA Data– VA Full Report & VA Summary Report
CDC-CPL – Histopathology
Report
70
80
110
120
CHAMPS Data Package Submission Timeline
Mortality Surveillance
Protocol
Site(s)
0 7
30
55
70
21 30
55
70
CDC-CPL
Specimen Receipt to Final
Report
0
50*
18
110
120
CASPI
R
Quarterly
CHAMPS Case Definitions
Standardize the cause of death determinations across the network
Adapted to take into consideration of all of CHAMPS data elements (i.e. verbal
autopsy, clinical data, clinical diagnostics, TAC results, histopathology)
Classified into different levels aligning with confirmed, probable and possible
designations
Definitions will contain the associated ICD-10 codes that correspond to those
conditions
Not an exhaustive list at this time but captures majority of causes suspected to be
determined
• There will be specific syndrome definitions tailored to CHAMPS infectious
agents being detected by TAC and/or immunohistochemistry
• E.g. Pneumonia due to Streptococcus pneumoniae
•
19
Will not contain definitions for conditions that CHAMPS procedures will not
specifically detect (e.g. congenital heart defects, intoxications)
Case Definitions for DeCoDe- based on PHMRC Gold Standard Diagnoses
(Popul Health Metr. 2011 Aug 4;9:27)
Neonatal Conditions
• Birth asphyxia
• Congenital malformation
• Meningitis
• Neonatal tetanus
• Pneumonia
• Preterm delivery w/out
RDS
• Preterm delivery with RDS
• Sepsis
• Sepsis w/ local bacterial
infection
• Stillbirth
Neonatal Co-morbidities
• Preterm delivery (w/o
RDS) AND Birth asphyxia
• Preterm delivery AND
Sepsis
• Preterm delivery (w/o
RDS) AND Sepsis AND
Birth asphyxia
20
Childhood (Age ≥28d) ID
Conditions
• AIDS
• AIDS with Tuberculosis
• Diarrhea
• Dysentery
• Encephalitis
• Hemorrhagic Fever
• Malaria
• Measles
• Meningitis
• Pertussis
• Pneumonia
• Sepsis
• Sepsis with local bacterial
infection
• Syphilis
• Tuberculosis (only
pulmonary TB)
Childhood Co-morbidities
• Pneumonia AND diarrhea
Childhood Injuries
• Bite of venomous animal
• Drowning
• Falls
• Fires
• Poisonings
• Road Traffic
• Violent Death
Other
• Malnutrition
• Childhood Residual Diseases
• Malignant neoplasms
• Cardiovascular diseases
• Respiratory diseases
• Digestive diseases
ICD-10 code
21
Case Report Form (DeCoDe Results)
22
•
Direct cause of death in child or main disease/condition in fetus or infant (Line A on
WHO Death Certificate)
•
Morbid condition #1 or other condition in fetus or infant (Line B)
•
Morbid condition #2 (Line C)
•
Underlying cause or factor (Line D)
•
Main maternal disease/condition affecting fetus or infant
•
Other maternal disease/condition affecting fetus or infant
•
For each of the above there will be a score of 1-3 determined by case definition or level
of confidence (1 most confident or confirmed case and 3 least confident or possible
case)
•
Other significant conditions contributing to death but not related to cause of death
disease (Part II of WHO Death Certificate)
•
Score of influence of each data packet on determination of cause of death
•
If case should be marked for in-depth discussion by full panel
ICD-10 Coding and Final Submission
• The individual reports and the panel report will be ICD-10 coded manually by
trained site member (designated by site director)
• Coding may be done by automated software (e.g. Iris) in future (local
dictionaries need to be built)
• All DeCoDe forms (Individual Reports, Panel Report and ICD-10 code Reports)
for the case will be submitted to the CHAMPS data web portal. This should
occur by 110-120 days post death
23
Assigning ICD-10 codes
24
Assigning ICD-10 codes
Inclusion terms
Exclusion terms
25
Central Review
• A medical certifier(s) in the CHAMPS Program Office will review the
determinations of all cases from all sites to assess standardization across sites,
produce recommendations for future case definitions, quality improvement
across the network
26
Questions?
27