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首页> 外文期刊>Obstetrics and Gynecology: Journal of the American College of Obstetricians and Gynecologists >Correlation between stillbirth vital statistics and medical records.
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Correlation between stillbirth vital statistics and medical records.

机译:死产生命统计数据与病历之间的相关性。

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摘要

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 kappa coefficient for categorical variables or Kendall's tau-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 chi 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). CONCLUSION: 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.
机译:目的:与死胎相关或促成死胎的大多数数据均来自胎儿死亡证明。我们的目的是将生命统计数据中记录的死产数据与病历中的死产数据进行比较,并调查三级护理和社区医院的诊断评估是否有所不同。方法:在这项横断面研究中,胎儿​​死亡证书数据确定了1998年至2002年间盐湖城八家医院中有死胎的人。对医疗记录进行了回顾,以评估人口统计学,诊断性评估和死胎的潜在原因。通过计算连续变量的一致和不一致对的数目,通过计算分类变量的kappa系数或Kendall tau-b系数,比较了死亡证明和病历之间的数据。使用chi或Fisher精确检验将社区和三级医院的诊断检验进行了比较。结果:鉴定出五百六十六个人,并且可以查看461(83%)个图表。对于人口统计学变量(相关性0.8-0.9),死亡证书和病历之间的相关性几乎是完美的,但对于促成因素或病因因素,其相关性则微弱至中等(相关性0.2-0.5)。与社区医院相比,在三级医疗中进行重要诊断检查的频率显着更高,包括尸检(35%比13%,P <.01),核型(17%比4%,P <.01),Kleihauer-Betke(22%)与13%相比,P = .01),毒理学筛查(13%与2%,P <.01)和全血细胞计数(95%与90%,P = .03)。结论:胎儿死亡证明与病历之间存在重要差异。完成检查,检查病历和增加准确报告的工作可能会提高死产生命统计的准确性。三级医院的诊断评估更为广泛。

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