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Áreiðanleiki dánarvottorða

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Authors
Jóhannes Björnsson
Jón Gunnlaugur Jónasson
Gunnlaugur P. Nielsen
Issue Date
1992-05-01

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Citation
Læknablaðið 1992, 78(5):181-5
Abstract
Death certificates are a crucial source of vital statistics in society. Major policy decisions and the allocation of funds in the health sector are based on data derived from death certificates. Autopsy, despite its limitations, remains the standard against which ante mortem clinical diagnoses may best be measured. Further, the reliability of death certificates should be enhanced for those deaths, where autopsy was performed. We compared the entries on death certificates with autopsy reports for autopsies performed at three hospitals in. Reykjavik during two years, 1976 (250 cases) and 1986 (339 cases), excluding stillbirths, perinatal and forensic deaths. Overall discrepancy between death certificates and autopsy reports was 49% (1976) and 48% (1986). For immediate cause of death, discrepancies were observed in 24% (1976) and 26% (1986) of cases. For major diseases other than the immediate cause of death, discrepancies were seen in 32% (1976) and 34% (1986). We investigated changes in discrepancy when the death certificate was signed before (38 autopsies) or on the same day or later (551 autopsies) than the autopsy. No significant improvement occurred except for other major disease, where discrepancies dropped from 45% to 33%. We conclude that death certificates 1. are an unreliable source of information on causes of death and major contributing diseases, 2. do not appear to be completed using information obtained at autopsy, even when such information is accessible. 3. have not improved with the introduction, between 1976 and 1986, of sophisticated imaging techniques.
Dánarvottorð veita mikilvægar upplýsingar um heilbrigði hvers þjóðfélags og byggja ákvarðanir um ráðstöfun opinberra fjármuna meðal annars á upplýsingum af dánarvottorðum. Krufning (líkrannsókn) er enn í fullu gildi til ákvörðunar sjúkdómsgreiningu og aðdraganda dauða og mætti ætla, að dánarvottorð krufinna væru áreiðanlegri en hinna er eigi voru krufðir. Bornar voru saman krufninganiðurstöður og færslur á dánarvottorð 589 látinna fyrir tvö ár með tíu ára millibili, 1976 (250 skýrslur) og 1986 (339 skýrslur). Misræmi fannst í 49% (1976) og 48% (1986) tilvika. Hvað varðar beina dánarorsök var misræmi í 24% (1976) og 26% (1986) skýrslna og hvað varðar alvarlega sjúkdóma aðra en beina dánarorsök var misræmi í 32% (1976) og 34% (1986). Misræmi var kannað eftir því hvort dánarvottorð var ritað á undan (38 skýrslur) eða sama dag (eða síðar) (551 skýrslna) og frumgreining krufningar. Ekki dró úr misræmi nema hvað varðaði aðra sjúkdóma en beina dánarorsök, þar féll misræmi úr 45% í 33%. Samkvæmt þessari athugun virðast dánarvottorð: 1. Óáreiðanleg heimild um dánarorsakir og aðra alvarlega sjúkdóma. 2. Ekki aukast að marktæki þótt vottorðsritari hafi handbærar niðurstöður krufningar. 3. Ekki aukast að marktæki frá 1976-1986 þrátt fyrir framfarir í rannsóknaraðferðum á sjúkrahúsum.
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