title: Correlation between stillbirth vital statistics and medical records.
abstract: OBJECTIVE
  Most data regarding conditions associated with or contributing to stillbirth are derived from fetal death certificates. Our purposes were to compare stillbirth data recorded in vital statistics with those in the medical record and to investigate whether diagnostic evaluations differed in tertiary care and community hospitals.
  
  
  METHODS
  In this cross-sectional study, fetal death certificate data identified individuals with stillbirths delivering in eight Salt Lake City hospitals from 1998 to 2002. Medical records were reviewed to assess demographics, diagnostic evaluation, and potential causes of stillbirth. Data were compared between death certificates and the medical record by calculation of the κ coefficient for categorical variables or Kendall's τ-b coefficients based on the number of concordant and discordant pairs of observations for continuous variables. Diagnostic tests completed were compared between community and tertiary care hospitals with χ or Fisher exact test.
  
  
  RESULTS
  Five-hundred fifty-six individuals were identified, and 461 (83%) charts were available for review. Correlation between death certificates and the medical record was nearly perfect for demographic variables (correlation 0.8-0.9) but slight to moderate (correlation 0.2-0.5) for contributing or etiologic factors. Important diagnostic tests performed significantly more often in tertiary care than community hospitals included autopsy (35% compared with 13%, P<.01), karyotype (17% compared with 4%, P<.01), Kleihauer-Betke (22% compared with 13%, P=.01), toxicology screen (13% compared with 2%, P<.01), and complete blood count (95% compared with 90%, P=.03).
  
  
  CONCLUSIONS
  There are important discrepancies between fetal death certificates and medical records. Complete work-up, review of the medical record, and efforts to increase accurate reporting may improve the accuracy of stillbirth vital statistics. Diagnostic evaluation was more extensive in tertiary care hospitals.
authors.affiliation: From the Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; the Utah Department of Health, Salt Lake City, Utah; and the Department of Statistics, Haifa University, Haifa, Israel.
authors.forename: Cara C
authors.initials: CC
authors.lastname: Heuser
authors.forename: Jessica
authors.initials: J
authors.lastname: Hunn
authors.forename: Michael
authors.initials: M
authors.lastname: Varner
authors.forename: Shaheen
authors.initials: S
authors.lastname: Hossain
authors.forename: Shiraz
authors.initials: S
authors.lastname: Vered
authors.forename: Robert M
authors.initials: RM
authors.lastname: Silver
mesh_terms: D002423:Cause of Death; D003644:Death Certificates; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D006801:Humans; D008499:Medical Records; D011247:Pregnancy; D050497:Stillbirth