title: Accidents and undetermined deaths: re-evaluation of nationwide samples from the Scandinavian countries.
abstract: National mortality statistics should be comparable between countries that use the World Health Organization's International Classification of Diseases. Distinguishing between manners of death, especially suicides and accidents, is a challenge. Knowledge about accidents is important in prevention of both accidents and suicides. The aim of the present study was to assess the reliability of classifying deaths as accidents and undetermined manner of deaths in the three Scandinavian countries and to compare cross-national differences.
  
  
  
  The cause of death registers in Norway, Sweden and Denmark provided data from 2008 for samples of 600 deaths from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of deaths and 200 as natural deaths. The information given to the eight experts was identical to the information used by the Cause of Death Register. This included death certificates, and if available external post-mortem examinations, forensic autopsy reports and police reports.
  
  
  
  In total, 69 % (Sweden and Norway) and 78 % (Denmark) of deaths registered in the official mortality statistics as accidents were confirmed by the experts. In the majority of the cases where disagreement was seen, the experts reclassified accidents to undetermined manner of death, in 26, 25 and 19 % of cases, respectively. Few cases were reclassified as suicides or natural deaths. Among the extracted accidents, the experts agreed least with the official mortality statistics concerning drowning and poisoning accidents. They also reported most uncertainty in these categories of accidents. In a second re-evaluation, where more information was made available, the Norwegian psychiatrist and forensic pathologist increased their agreement with the official mortality statistics from 76 to 87 %, and from 85 to 88 %, respectively, regarding the Norwegian and Swedish datasets. Among the extracted undetermined deaths in the Swedish dataset, the two experts reclassified 22 and 51 %, respectively, to accidents.
  
  
  
  There was moderate agreement in reclassification of accidents between the official mortality statistics and the experts. In the majority of cases where there was disagreement, accidents were reclassified as undetermined manner of death, and only a small proportion as suicides.
authors.affiliation: Department of Acute Medicine, Oslo University Hospital Ullevaal, Box 4950, Nydalen, N-0424, Oslo, Norway. uxtlli@ous-hf.no.|Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1072, Blindern, N-0316, Oslo, Norway. uxtlli@ous-hf.no.|Division of Medicine, Department of Acute Medicine, Oslo University Hospital Ullevaal, Box 4950, Nydalen, N-0424, Oslo, Norway. uxtlli@ous-hf.no.
authors.forename: Ingvild Maria
authors.initials: IM
authors.lastname: Tøllefsen
authors.affiliation: Department of Surgical Sciences, Uppsala University, Box 256, 751 05, Uppsala, Sweden.
authors.forename: Ingemar
authors.initials: I
authors.lastname: Thiblin
authors.affiliation: Department of Social Medicine and Public Health Research, Copenhagen University, Nørregade 10, Copenhagen K, DK-1165, Denmark.
authors.forename: Karin
authors.initials: K
authors.lastname: Helweg-Larsen
authors.affiliation: Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1072, Blindern, N-0316, Oslo, Norway.|Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Box 4950, Nydalen, N-0424, Oslo, Norway.
authors.forename: Erlend
authors.initials: E
authors.lastname: Hem
authors.affiliation: , Amalievej 23, Frederiksberg, DK 1875, Denmark.
authors.forename: Marianne
authors.initials: M
authors.lastname: Kastrup
authors.affiliation: Stockholm Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Sweden, Norra Stocholms psychiatri S:t Görans sjukhus, Stockholm, SWE-112 81, Sweden.
authors.forename: Ullakarin
authors.initials: U
authors.lastname: Nyberg
authors.affiliation: Norwegian Institute of Public Health, Box 4404, Nydalen, N-0403, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Box 1072, Blindern, N- 0316, Oslo, Norway.
authors.forename: Sidsel
authors.initials: S
authors.lastname: Rogde
authors.affiliation: Norwegian Institute of Public Health, Box 4404, Nydalen, N-0403, Oslo, Norway.
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Zahl
authors.affiliation: Norwegian Institute of Public Health, Box 4404, Nydalen, N-0403, Oslo, Norway.
authors.forename: Gunvor
authors.initials: G
authors.lastname: Østevold
authors.affiliation: Department of Behavioural Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Box 1072, Blindern, N-0316, Oslo, Norway.|Division of Mental Health and Addiction, Oslo University Hospital Ullevaal, Box 4950, Nydalen, N-0424, Oslo, Norway.
authors.forename: Øivind
authors.initials: Ø
authors.lastname: Ekeberg
mesh_terms: D000059:Accidents / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D066264:Datasets as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012537:Scandinavian and Nordic Countries / Q000453:epidemiology; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Accidents; Autopsy; Reclassification; Suicide statistics; Undetermined deaths