Coding pulmonary sepsis and mortality statistics in Rio de Janeiro, RJ

ABSTRACT: Objectives: 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. Methods: 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. Results: "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. Conclusion: 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.

摘要：
研究目的：本研究旨在描述被列为死亡原因的"肺脓毒症"，探究其与肺炎的关联，以及死亡统计编码规则的重要性，具体涵盖2011年巴西里约热内卢地区标注有"肺脓毒症"的死亡证明书（Death Certificate, DC）中的肺炎诊断情况。
研究方法：本研究对所有提及"肺脓毒症"的死亡证明书进行了识别，不考虑其根本死亡病因。针对标注"肺脓毒症"的死亡证明书所关联的医疗记录开展回顾性审查，并访谈相关医师以量化肺脓毒症与肺炎之间的关联。本研究通过为标注"肺脓毒症"的死亡证明书填入肺炎对应的国际疾病分类第10版（International Classification of Diseases, ICD-10）编码，对死亡数据进行模拟分析。
研究结果："肺脓毒症"占报告脓毒症病例的30.9%，其中51.3%的死亡证明书未提及肺炎。在医疗记录样本中，82.8%的记录标注有肺炎。受访医师中，93.3%的医师表示肺炎是"肺脓毒症"最常见的致病原因。编码流程模拟结果显示，在报告脓毒症的死亡病例中，有7.8%的病例其根本死亡原因发生了变更；而在所有死亡病例中，这一变更比例为2.4%，且与原始死因无关。
研究结论：本研究证实，"肺脓毒症"与肺炎存在高频关联，在死亡证明书中加入肺炎的ICD-10编码可能会对死亡统计数据产生影响，这凸显了优化死亡统计编码规则的迫切需求。