Validation of a classification system for causes of death in critical care: an assessment of inter-rater reliability.
Crit Care Resusc
; 18(1): 50-4, 2016 Mar.
Article
em En
| MEDLINE
| ID: mdl-26947416
ABSTRACT
OBJECTIVE:
Trials in critical care have previously used unvalidated systems to classify cause of death. We aimed to provide initial validation of a method to classify cause of death in intensive care unit patients. DESIGN, SETTING ANDPARTICIPANTS:
One hundred case scenarios of patients who died in an ICU were presented online to raters, who were asked to select a proximate and an underlying cause of death for each, using the ICU Deaths Classification and Reason (ICU-DECLARE) system. We evaluated two methods of categorising proximate cause of death (designated Lists A and B) and one method of categorising underlying cause of death. Raters were ICU specialists and research coordinators from Australia, New Zealand and the United Kingdom. MAIN OUTCOMEMEASURES:
Inter-rater reliability, as measured by the Fleiss multirater kappa, and the median proportion of raters choosing the most likely diagnosis (defined as the most popular classification choice in each case).RESULTS:
Across all raters and cases, for proximate cause of death List A, kappa was 0.54 (95% CI, 0.49-0.60), and for proximate cause of death List B, kappa was 0.58 (95% CI, 0.53-0.63). For the underlying cause of death, kappa was 0.48 (95% CI, 0.44-0.53). The median proportion of raters choosing the most likely diagnosis for proximate cause of death, List A, was 77.5% (interquartile range [IQR], 60.0%-93.8%), and the median proportion choosing the most likely diagnosis for proximate cause of death, List B, was 82.5% (IQR, 60.0%-92.5%). The median proportion choosing the most likely diagnosis for underlying cause was 65.0% (IQR, 50.0%-81.3%). Kappa and median agreement were similar between countries. ICU specialists showed higher kappa and median agreement than research coordinators.CONCLUSIONS:
The ICU-DECLARE system allowed ICU doctors to classify the proximate cause of death of patients who died in the ICU with substantial reliability.
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Temas:
ECOS
/
Aspectos_gerais
Bases de dados:
MEDLINE
Assunto principal:
Causas de Morte
/
Cuidados Críticos
Tipo de estudo:
Etiology_studies
Limite:
Humans
País/Região como assunto:
Europa
/
Oceania
Idioma:
En
Revista:
Crit Care Resusc
Assunto da revista:
TERAPIA INTENSIVA
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Nova Zelândia