Comparison of two methods for the discrimination of avoidable perinatal deaths.
This paper analyzes the validity and reliability of a method proposed by HERMAN et al [8] used to classify avoidable neonatal deaths. This method is based on a list of amenable medical conditions with an a priori decision about the avoidance of deaths. The results obtained using this method are compared to those derived from the discussion of individual cases by a committee created ex profeso. The population under study includes all neonatal deaths occurred at a third level hospital in Mexico City, from January 1, 1987 to July 31, 1994 (n = 1337). Only 56% of neonatal deaths could follow HERMAN's classification (n = 749). Poor concordance (Cohen's Kappa = 0.30) between the two methods was found. A high proportion of deaths (72.7%) was classified ambiguously (as possibly preventable), and also a considerable proportion of deaths could not be classified (44%). High sensitivity (96%) was found for the small percentage of cases in which avoidance was determined by the method under assessment (15%). A priori classification is useful for developing rough quality indicators at the regional level but not at hospital settings.
Coria-Soto
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I
Department of Analysis and Statistics, National Institute of Perinatology, Col. Lomas Virreyes, México.
Zambrana-Castañeda
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M
Reyes-Zapata
H
H
Salinas-Martinez
A M
AM
D002423:Cause of Death; D005313:Fetal Death / Q000145:classification / Q000517:prevention & control; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008800:Mexico; D011446:Prospective Studies; D015203:Reproducibility of Results