K-506. Specificity and Sensitivity of Recording Clostridium difficile on Death Certificates Using UK Healthcare Commission Criteria
Session: Poster Session: Epidemiology and Management of C. difficile
Saturday, October 25, 2008: 12:00 AM
Room: Hall C
Background: UK death certification is used to derive data on deaths from C difficile infection (CD). In 2006, certificates in England & Wales mentioning CD increased by 72%. The UK Healthcare Commission (HCC) uses standard criteria to categorise contribution to death as definite, probable, possible, unlikely or not. We assessed sensitivity and specificity of a record of CD on death certificates against the HCC criteria. Methods: Hospital in-patients who died Nov 2007-Jan 2008 and had a diagnosis of CD during their admission were included. Two reviewers assessed case notes and categorised the contribution of CD to death using HCC criteria. Sensitivity and specificity of CD on the death certificate was calculated. A sensitivity analysis was done to assess effect of variations in use of the ‘possible’ category. Results: 28 patients were included. In the 13 cases where CD was recorded on the death certificate, this was accurate according to HCC criteria. Certification of death due to CD was highly specific (100%) irrespective of the accuracy of the ‘possible’ category. Sensitivity depended on the accuracy of assessment of the ‘possible’ category by reviewers and was 60% or 93% respectively if the ‘possible’ category was altered to ‘unlikely’ or ‘probable’. Therefore in 7 to 40% of cases, CD should have been mentioned on the death certificate when it was not. Conclusions: Sensitivity of death certification for CD depended on accurate assessment of the ‘possible’ category. It could be improved by training and better case note documentation.
Assessment of Contribution of CD to Death Using HCC criteria
Reviewers' AssessmentCD Mentioned on Death Certificate
YesNoTotal
Definite101
Probable516
Possible7815
Unlikely055
Not011
Total131528
Cheryl Trundle1, Fiona Head1, Nicholas Brown1, Olajumoke Sule2, Shylaja Thomas1 and  O. Sule, None., (1)Addenbrookes Hospital, (2)Addenbrookes Hospital, Cambridge, United Kingdom