Evaluating the accuracy of International Classification of Disease Perinatal Mortality (ICD-PM) codes assigned on death certificates before and after expert panel review: a mixed methods observational study

• Published in: BMC pregnancy and childbirth 2024-10, Vol.24 (1), p.643-10, Article 643
• Main Authors: Jafari, Masoumeh, Meraji, Marziyhe, Mirteimouri, Masoumeh, Heidarzadeh, Mohammad
• Format: Article
• Language: English
• Subjects: Autopsies; Cause of Death; Causes of death; Classification; Codes; Death Certificates; Female; Hospitals; Humans; ICD-PM; Infant, Newborn; International Classification of Diseases; Mortality; Observational studies; Perinatal Death - etiology; Perinatal Death - prevention & control; Perinatal Mortality; Pregnancy; Registration; Stillbirth; Stillbirth - epidemiology
• ISSN: 1471-2393; 1471-2393
• DOI: 10.1186/s12884-024-06855-8

The present study was conducted with the aim of evaluating the accuracy of International Classification of Disease Perinatal Mortality (ICD-PM) codes assigned on death certificates before and after an expert panel review. The present study was a mixed methods observational study conducted at Umm al-Benin Hospital, the sole specialized obstetrics and gynecology center affiliated with Mashhad University of Medical Sciences. The study comprised three distinct stages: (1) Collecting primary ICD-PM codes assigned to perinatal death certificates, along with other relevant information, from October 2021 to March 2022; (2) Examining the circumstances of each perinatal death case and re-identifying the causes of death through a consensus process involving a panel of experts comprising pediatricians, obstetrics and gynecology specialists, and nursing and midwifery experts; presenting the new ICD-PM code; (3) Comparing the ICD-PM codes assigned to perinatal death certificates before and after the expert panel's evaluation. During the study period, a total of seven specialized panels were conducted to examine perinatal deaths. Out of the 71 cases, 41 were carefully reviewed by experts. These cases included 32 stillbirths and nine neonatal deaths. The examination process followed specific inclusion and exclusion criteria. The findings revealed that there were no significant changes in the causes of neonatal deaths. However, it was notable that 80% of the previously unknown causes of stillbirths were successfully identified. Notably, the occurrence of stillbirths increased by 78% due to maternal causes and conditions. Convening panels of experts to discuss the causes of perinatal deaths can effectively reduce the percentage of unknown causes, as classified by ICD-PM. This approach also guarantees the availability of essential data for implementing effective interventions to decrease preventable perinatal deaths.