Worth the paper it's written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK
Worth the paper it's written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK
Background: The Medical Certificate of Stillbirth (MCS) records data about a baby's death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. Methods: A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual 'ideal MCSs' and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. Results: There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70-0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24-0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3-64.9%)] included certificates issued for fetal demise at <24 weeks' gestation [23/696; 3.3% (95% CI 2.2-4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1-1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1-97.1%)]. Of 540/1246 [43.3% (95% CI 40.6-46.1%)] 'unexplained' stillbirths, only 119/540 [22.0% (95% CI 18.8-25.7%)] remained unexplained; the majority were redesignated as either fetal growth restriction [FGR: 195/540; 36.1% (95% CI 32.2-40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2-38.2)]. Overall, FGR [306/1246; 24.6% (95% CI 22.3-27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5-22.1%)] FGR cases were originally attributed correctly. Conclusion: This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory.
Stillbirth, accuracy, cause of death, death certification, fetal growth restriction, perinatal death, placental insufficiency, stillbirth certification
295-308
Rimmer, Michael P.
fd46f769-856e-413f-a5d0-9af6a2bb2a97
Henderson, Ian
93691a93-543f-46dd-963d-4cad50581fd7
Parry-Smith, William
7bdb9240-c6f5-432a-82eb-18565c17e354
Stocker, Linden
6990b82e-4431-4e32-8250-309d61e1a01b
1 February 2023
Rimmer, Michael P.
fd46f769-856e-413f-a5d0-9af6a2bb2a97
Henderson, Ian
93691a93-543f-46dd-963d-4cad50581fd7
Parry-Smith, William
7bdb9240-c6f5-432a-82eb-18565c17e354
Stocker, Linden
6990b82e-4431-4e32-8250-309d61e1a01b
Rimmer, Michael P., Henderson, Ian and Parry-Smith, William
,
UKARCOG NESTT
(2023)
Worth the paper it's written on? A cross-sectional study of Medical Certificate of Stillbirth accuracy in the UK.
International Journal of Epidemiology, 52 (1), .
(doi:10.1093/ije/dyac100).
Abstract
Background: The Medical Certificate of Stillbirth (MCS) records data about a baby's death after 24 weeks of gestation but before birth. Major errors that could alter interpretation of the MCS were widespread in two UK-based regional studies. Methods: A multicentre evaluation was conducted, examining MCS issued 1 January 2018 to 31 December 2018 in 76 UK obstetric units. A systematic case-note review of stillbirths was conducted by Obstetric and Gynaecology trainees, generating individual 'ideal MCSs' and comparing these to the actual MCS issued. Anonymized central data analysis described rates and types of error, agreement and factors associated with major errors. Results: There were 1120 MCSs suitable for assessment, with 126 additional submitted data sets unsuitable for accuracy analysis (total 1246 cases). Gestational age demonstrated 'substantial' agreement [K = 0.73 (95% CI 0.70-0.76)]. Primary cause of death (COD) showed 'fair' agreement [K = 0.26 (95% CI 0.24-0.29)]. Major errors [696/1120; 62.1% (95% CI 59.3-64.9%)] included certificates issued for fetal demise at <24 weeks' gestation [23/696; 3.3% (95% CI 2.2-4.9%)] or neonatal death [2/696; 0.3% (95% CI 0.1-1.1%)] or incorrect primary COD [667/696; 95.8% (95% CI 94.1-97.1%)]. Of 540/1246 [43.3% (95% CI 40.6-46.1%)] 'unexplained' stillbirths, only 119/540 [22.0% (95% CI 18.8-25.7%)] remained unexplained; the majority were redesignated as either fetal growth restriction [FGR: 195/540; 36.1% (95% CI 32.2-40.3%)] or placental insufficiency [184/540; 34.1% (95% CI 30.2-38.2)]. Overall, FGR [306/1246; 24.6% (95% CI 22.3-27.0%)] was the leading primary COD after review, yet only 53/306 [17.3% (95% CI 13.5-22.1%)] FGR cases were originally attributed correctly. Conclusion: This study demonstrates widespread major errors in MCS completion across the UK. MCS should only be completed following structured case-note review, with particular attention on the fetal growth trajectory.
Text
dyac100
- Version of Record
More information
Accepted/In Press date: 22 April 2022
e-pub ahead of print date: 20 June 2022
Published date: 1 February 2023
Additional Information:
Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the International Epidemiological Association.
Keywords:
Stillbirth, accuracy, cause of death, death certification, fetal growth restriction, perinatal death, placental insufficiency, stillbirth certification
Identifiers
Local EPrints ID: 483485
URI: http://eprints.soton.ac.uk/id/eprint/483485
ISSN: 0300-5771
PURE UUID: d2c1b915-0398-46a5-89c8-3206db24b008
Catalogue record
Date deposited: 31 Oct 2023 18:15
Last modified: 17 Mar 2024 05:10
Export record
Altmetrics
Contributors
Author:
Michael P. Rimmer
Author:
Ian Henderson
Author:
William Parry-Smith
Author:
Linden Stocker
Corporate Author: UKARCOG NESTT
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics