A Public Health Partnership: The OCME and Vital Statistics

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A Public Health PartnershipThe OCME and Vital
Statistics
Jane Purtill, M.S. Director, Statistics
Unit Registry of Vital Records and
Statistics Center for Health Information,
Statistics, Research and Evaluation Massachusetts
Department of Public Health Stanley E. Nyberg,
Ph.D. State Registrar Registry of Vital Records
and Statistics Center for Health Information,
Statistics, Research and Evaluation Massachusetts
Department of Public Health
Portions of this presentation were provided
by Centers for Disease Control and
Prevention National Center for Health Statistics
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Report of Fetal Death

• Massachusetts General Law Chapter 111 section 202
  governs the reporting of fetal death information.
• death prior to the complete expulsion or
  extraction from its mother
• If a fetus weighs 350 grams or more OR is twenty
  weeks gestation or more, it is reportable to DPH
  within 10 days of the event.

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Report of Fetal Death

• When a fetal death occurs without medical
  attendance. or when the fetal death may have
  occurred from violence or unnatural causes the
  medical examiner shall investigate the cause

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Report of Fetal Death

• Pregnancy and Delivery information are captured
  on the back of the Report of Fetal Death
• Information is similar to what is collected on
  the statistical portion of the birth certificate
  and is used to assess birth outcomes.

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Report of Fetal Death

• Hospital or ME Transmits Directly to RVRS
• Board of Health may receive a copy for
  disposition permit
• Annie Hobbs [phone]

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Report of Fetal Death

• Reports are confidential and shall be released
  only upon written request of the parent, executor
  or any other person designated by the parent in
  writing.
• Beginning in 2002, parents may now request a
  Certificate of Birth Resulting in Stillbirth
  provided there is a Report of Fetal Death

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Reports of Fetal Death by Year
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2005 Preliminary Data Reports of Fetal Death

• Cause of Death
• 1) Fetal death of unspecified cause
• 2) Unknown
• 3) Compression of umbilical cord
• 4) Extreme immaturity
• 5) Placental separation and hemorrhage
• 6) Premature rupture of membrane

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Data Entry

• Records are data entered by DPH IT
• Shipments tracked - separate demographic
  medical
• Index created
• Statistical database merged on mainframe
• Upon return, volumes readied for binding

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Cause of Death Coding

• Trained nosologists
• SuperMICAR
• Underlying cause of death
• ICD-10 in 1999

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Cause of Death Coding

• Trained nosologists
• SuperMICAR
• Underlying cause of death
• ICD-10 in 1999

Bob Coffin (!), Nosologist
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More Processing...

• Infant Death Match
• Edits - Internal Federal
• Out-of-State coding for Massachusetts residents
• Interstate Exchange for non-MA residents
• NCHS Samples

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More Processing...

• Infant Death Match
• Edits - Internal Federal
• Out-of-State coding for Massachusetts residents
• Interstate Exchange for non-MA residents
• NCHS Samples

• Ann-Marie Neault, Nosologist

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Childhood Deaths by Certifier, Massachusetts
Occurrence Deaths 2004-20051
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Deaths Certified by Medical Examiner for Selected
Causes of Death, Massachusetts Occurrence Deaths
2004 20051
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Proportion of Deaths Certified by Medical
Examiner for Selected Causes of Death,
Massachusetts Occurrence Deaths 20051
1 2005 data is preliminary.
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1 2005 data is preliminary.
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Example

• A 2-year-old female was admitted to the hospital
  with salicylate poisoning. She had been under
  treatment for tonsillitis and upper respiratory
  infection. She had been given multiple excessive
  doses of aspirin (adult rather than baby
  tablets).

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Example Immediate cause
Approximate interval between onset and death
Acute salicylate poisoning
23 hours
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Example Antecedent causes
Approximate interval between onset and death
Acute salicylate poisoning
23 hours
Overdose of aspirin
23 hours
Treatment for acute tonsillitis
2 days
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Example Other significant conditions
Approximate interval between onset and death
Acute salicylate poisoning
23 hours
Overdose of aspirin
23 hours
Treatment for acute tonsillitis
2 days
Upper respiratory infection
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Autopsy ME Notification ItemsNever leave blank
Therapeutic Complication

• Item 31 Was Autopsy Performed?
• Yes (even if partial) or No
• Item 32 Were Autopsy Findings Available Prior to
  Completion of Cause of Death?
• Yes or No
• Item 33 Medical Examiner Notified?
• If this is an ME case, this item should always
  say Yes

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Report of Fetal Death

• Hospital or ME Transmits Directly to RVRS
• Board of Health may receive a copy for
  disposition permit
• Annie Hobbs [phone]

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Report of Fetal Death
433 in 2004

• For perinatal and maternal mortality statistics
  the Report of Fetal Death is as important as the
  Death Certificate, yet most items are blank.
• Report all fetal deaths, including those
  extracted by autopsy, where weeks at extraction
  or expulsion is 20 or more, or the weight of the
  fetus is 350 grams or more please dont forget
  to send them to RVRS.
• Dont wait, report within 10 days pending
  investigation is also appropriate for fetal
  deaths
• Beginning in 2002, parents may now request a
  Certificate of Birth Resulting in Stillbirth
  provided there is a Report of Fetal Death

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Birth Certificates

• Occasionally, the ME will be responsible for a
  birth certificate (e.g., foundling)
• There is a legal portion of the birth certificate
  and a statistical portion. Both must be
  completed.
• Because rare, call RVRS for instructions

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Registration Issues

• All death certificates deserve some TLC
• Timeliness
• Legibility
• Completeness

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Timeliness

• RVRS is currently finishing the 2004 death file
  There are still 80 pending investigation records
  not complete

Legibility

• RVRS needs to data enter for statistics
• Your name is on every certified and archival
  copy, along with your handwriting responses

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Completeness

• In addition to answering every item, completeness
  means answering every item completely

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1916 Death Certificate
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Todays Death Certificate Have we made
progress?
Of 423 total infant deaths, 21 were coded to
prematurity, not otherwise classified and
another 78 were coded to extreme immaturity