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Arch Dis Child 96:922-926 doi:10.1136/adc.2009.177089
  • Original articles

How children die: classifying child deaths

  1. D Kelly1
  1. 1Birmingham Children's Hospital, Birmingham, UK
  2. 2Newcastle University, Newcastle upon Tyne, UK
  1. Correspondence to Dr G A Pearson, Paediatric Intensive Care, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; Gale.Pearson{at}BCH.NHS.UK
  • Accepted 8 February 2010
  • Published Online First 23 July 2010

Abstract

Aim To validate a descriptive tool for the causes of child death, which was designed to circumvent problems posed by the analysis of a confidential enquiry.

Method 3 participants from different healthcare backgrounds used clinical data, including the entries on the medical certificate of the cause of death, to classify the root cause of 783 deaths from the Confidential Enquiry into Maternal and Child Health child death review. A bespoke hierarchical system was used. Unanimity of allocation within categories and inter-rater and intra-rater agreement were assessed. Two methods for treating disagreements were compared by assessing their effect upon the apparent incidence of different causes of death.

Results The participants were most consistent in grouping deaths due to trauma, malignancy and sudden infant death. Each was highly consistent in allocating cases to groups (κ 0.85–0.99), but the agreement between participants, although “good”, was worse (κ 0.66–0.78). The greatest number of discrepancies was between diseases identified as congenital by the doctor and as chronic medical conditions by others. The method for treating disagreement between participants does not affect the commonest cause of death (trauma) but alters the ranking of the subordinate causes.

Conclusion Agreement within diagnostic categories might be improved by greater training of assessors in the use of the technique. This level of performance compares well with that of other coding systems upon their target groups.

Footnotes

  • Funding Funding for the national confidential enquiry on which this article is based was provided by the National Patient Safety Agency and by the Department of Health, Social Services and Public Safety of Northern Ireland. The views of the authors are their own and do not necessarily represent those of the funding bodies.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the NW Multicentre Ethics Committee 05/mre08/51.

  • Provenance and peer review Not commissioned; externally peer reviewed.