Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers.
OBJECTIVE
To systematically review the reliability of hospital data on cause of death and encourage periodic reviews of these data using a standard method.


METHODS
We searched Google Scholar, Pubmed and Biblioteca Virtual de la Salud for articles in English, Spanish and Portuguese that reported validation studies of data on cause of death. We analysed the results of 199 studies that had used medical record reviews to validate the cause of death reported on death certificates or by the vital registration system.


RESULTS
The screened studies had been published between 1983 and 2013 and their results had been reported in English (n = 124), Portuguese (n = 25) or Spanish (n = 50). Only 29 of the studies met our inclusion criteria. Of these, 13 had examined cause of death patterns at the population level - with a view to correcting cause-specific mortality fractions - while the other 16 had been undertaken to identify discrepancies in the diagnosis for specific diseases before and after medical record review. Most of the selected studies reported substantial misdiagnosis of causes of death in hospitals. There was wide variation in study methodologies. Many studies did not describe the methods used in sufficient detail to be able to assess the reproducibility or comparability of their results.


CONCLUSIONS
The assumption that causes of death are being accurately reported in hospitals is unfounded. To improve the reliability and usefulness of reported causes of death, national governments should do periodic medical record reviews to validate the quality of their hospital cause of death data, using a standard.
University of Queensland, School of Population Health, Brisbane, Australia .
Rasika
R
Rampatige
LM Consulting, Brisbane, Australia .
Lene
L
Mikkelsen
Institute for Health Metrics and Evaluation, University of Washington, Seattle, United States of America .
Bernardo
B
Hernandez
University of Queensland, School of Population Health, Brisbane, Australia .
Ian
I
Riley
University of Melbourne, Melbourne School of Population and Global Health, Building 379, 207 Bouverie Street, Carlton 3053, Victoria, Australia .
Alan D
AD
Lopez
D002423:Cause of Death / Q000639:trends*; D003644:Death Certificates; D006291:Health Policy; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008499:Medical Records; D013223:Statistics as Topic