title: Clinicians didn't reliably distinguish between different causes of cardiac death using case histories.
abstract: OBJECTIVE
  Routine statistics and epidemiologic studies often distinguish between types of cardiac death. Our aim was to assess agreement between doctors on cause of death given identical clinical information, and to assess agreement between a physician panel and the original cause of death as coded on national statistics.
  
  
  METHODS
  Clinical information and autopsy reports on 400 cardiac deaths were randomly selected from a defined population in the West Midlands, UK. A panel of eight clinicians was assembled, and batches of 24-25 cases were sent to pairs of these clinicians who, blinded to the certified cause of death, independently of each other assigned underlying cause of death. Physician panel decision was achieved by consensus. Levels of agreement were assessed using the kappa statistic.
  
  
  RESULTS
  Reviewers agreed on cause of death in 54% of cases (kappa = 0.34). Consensus decision of reviewers agreed with death certificate diagnosis in 61.5% (kappa = 0.39). Agreement was higher if an autopsy had been performed (kappa = 0.49).
  
  
  CONCLUSIONS
  The process of identifying underlying cause of death is of limited reliability, and therefore, limited accuracy. This has implications for design of epidemiologic studies and clinical trials of cardiovascular disease.
authors.affiliation: Department of Primary Care and General Practice, Primary Care Clinical Sciences Building, University of Birmingham, Birmingham B15 2TT, United Kingdom. j.w.mant@bham.ac.uk
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mant
authors.forename: Sue
authors.initials: S
authors.lastname: Wilson
authors.forename: Jayne
authors.initials: J
authors.lastname: Parry
authors.forename: Pam
authors.initials: P
authors.lastname: Bridge
authors.forename: Richard
authors.initials: R
authors.lastname: Wilson
authors.forename: Will
authors.initials: W
authors.lastname: Murdoch
authors.forename: Terry
authors.initials: T
authors.lastname: Quirke
authors.forename: Michael
authors.initials: M
authors.lastname: Davies
authors.forename: Michael
authors.initials: M
authors.lastname: Gammage
authors.forename: Rebecca
authors.initials: R
authors.lastname: Harrison
authors.forename: Adrian
authors.initials: A
authors.lastname: Warfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D003644:Death Certificates; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010820:Physicians; D011237:Predictive Value of Tests