title: Coding pulmonary sepsis and mortality statistics in Rio de Janeiro, RJ.
abstract: This study aimed to describe "pulmonary sepsis" reported as a cause of death, measure its association to pneumonia, and the significance of the coding rules in mortality statistics, including the diagnosis of pneumonia on death certificates (DC) with the mention of pulmonary sepsis in Rio de Janeiro, Brazil, in 2011.
  DC with mention of pulmonary sepsis was identified, regardless of the underlying cause of death. Medical records related to the certificates with reference to "pulmonary sepsis" were reviewed and physicians were interviewed to measure the association between pulmonary sepsis and pneumonia. A simulation was performed in the mortality data by inserting the International Classification of Diseases (ICD-10) code for pneumonia in the certificates with pulmonary sepsis.
  "Pulmonary sepsis" constituted 30.9% of reported sepsis and pneumonia was not reported in 51.3% of these DC. Pneumonia was registered in 82.8% of the sample of the medical records. Among physicians interviewed, 93.3% declared pneumonia as the most common cause of "pulmonary sepsis." The simulation of the coding process resulted in a different underlying cause of death for 7.8% of the deaths with sepsis reported and 2.4% of all deaths, regardless the original cause.
  The conclusion is that "pulmonary sepsis" is frequently associated to pneumonia and that the addition of the ICD-10 code for pneumonia in DC could affect the mortality statistics, highlighting the need to improve mortality coding rules.
authors.affiliation: Secretaria Municipal de Saúde do Rio de Janeiro, Gerência Técnica de Dados Vitais - Rio de Janeiro (RJ), Brasil.
authors.forename: Bruno Baptista
authors.initials: BB
authors.lastname: Cardoso
authors.affiliation: Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva - Rio de Janeiro (RJ), Brasil.
authors.forename: Pauline Lorena
authors.initials: PL
authors.lastname: Kale
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002423:Cause of Death; D002648:Child; D059019:Clinical Coding; D003644:Death Certificates; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000401:mortality*; D018805:Sepsis / Q000175:diagnosis* / Q000401:mortality*; D014504:Urban Health; D055815:Young Adult