Asunto(s)
Humanos , Femenino , Embarazo , Mortalidad Perinatal , Edad Gestacional , Nacimiento Vivo , Muerte Fetal/clasificaciónRESUMEN
El estudio y certificación de las muertes ocurridas durante la etapa perinatal, y por ende de las muertes fetales, es diferente al de otras etapas de la vida, ya que los componenetes materno y placentario juegan un papel importante en las causas de muerte. Entonces es lógico pensar que al momento de realizar un estudio o certificar una muerte fetal, se tiene que indagar en los componentes señalados. El objeto del presente estudio fue establecer que el Certificado Médico Unico de Defunción (CEMEUD), no recolecta datos necesarios para un estudio y registro adecuado de la muerte fetal intrauterina. se realizó un estudio descriptivo retrospectivo, donde se realizó al CEMEUD como instrumento captador de información y certificador de la muerte fetal intrauterina...
Asunto(s)
Certificación/clasificación , Certificado de Defunción/historia , Muerte Fetal/clasificación , Métodos de Análisis de Laboratorio y de CampoRESUMEN
This paper analyzes the validity and reliability of a method proposed by HERMAN et al [8] used to classify avoidable neonatal deaths. This method is based on a list of amenable medical conditions with an a priori decision about the avoidance of deaths. The results obtained using this method are compared to those derived from the discussion of individual cases by a committee created ex profeso. The population under study includes all neonatal deaths occurred at a third level hospital in Mexico City, from January 1, 1987 to July 31, 1994 (n = 1337). Only 56% of neonatal deaths could follow HERMAN's classification (n = 749). Poor concordance (Cohen's Kappa = 0.30) between the two methods was found. A high proportion of deaths (72.7%) was classified ambiguously (as possibly preventable), and also a considerable proportion of deaths could not be classified (44%). High sensitivity (96%) was found for the small percentage of cases in which avoidance was determined by the method under assessment (15%). A priori classification is useful for developing rough quality indicators at the regional level but not at hospital settings.
PIP: Two methods for the identification of avoidable perinatal deaths (the first based on a Perinatal Mortality Committee [COMOPer] audit using the Ninth Revision of the International Disease Classification and the second on a computerized list developed by Herman et al.] were compared through use of data from the National Institute of Perinatology in Mexico City, Mexico. While the Herman method entails an a priori determination about the avoidability of deaths by cause, the other is derived from a discussion of individual cases by a committee of experts. Analyzed were the 1337 neonatal deaths occurring at the institution during 1987-94; fetal and infant deaths were excluded because of their lack of fit with the Herman model. Of the 749 neonatal deaths (56%) in which Herman's list could be applied, 173 were classified as avoidable, 541 as possibly avoidable, and 35 as nonavoidable. In contrast, COMOPer designated 230 of these same deaths as avoidable, 514 as nonavoidable, and 5 as undeterminable. Only 38% of neonatal deaths assessed by COMOPer as avoidable and 6% of those judged unavoidable were so classified by the Herman method. This extremely low concordance (Cohen's Kappa, 0.30) indicates the importance of a case-by-case analysis that takes into account the factors underlying the most frequent local pathologies as well as local health policies (e.g., the legality of abortion). Although an a priori classification system can enable the assessment of rough indicators of the quality of medical care at a regional level, a careful analysis of individual deaths by a multidisciplinary group of experts is important to identify deficiencies in the quality of care at the local hospital level.