An evaluation of classification systems for stillbirth - PubMed (original) (raw)

Multicenter Study

doi: 10.1186/1471-2393-9-24.

J Frederik Frøen, Halit Pinar, Rozbeh Torabi, Eli Saastad, Grace Guyon, Laurie Russell, Adrian Charles, Catherine Harrison, Lawrence Chauke, Robert Pattinson, Rachel Koshy, Safiah Bahrin, Glenn Gardener, Katie Day, Karin Petersson, Adrienne Gordon, Kristen Gilshenan

Affiliations

Multicenter Study

An evaluation of classification systems for stillbirth

Vicki Flenady et al. BMC Pregnancy Childbirth. 2009.

Abstract

Background: Audit and classification of stillbirths is an essential part of clinical practice and a crucial step towards stillbirth prevention. Due to the limitations of the ICD system and lack of an international approach to an acceptable solution, numerous disparate classification systems have emerged. We assessed the performance of six contemporary systems to inform the development of an internationally accepted approach.

Methods: We evaluated the following systems: Amended Aberdeen, Extended Wigglesworth; PSANZ-PDC, ReCoDe, Tulip and CODAC. Nine teams from 7 countries applied the classification systems to cohorts of stillbirths from their regions using 857 stillbirth cases. The main outcome measures were: the ability to retain the important information about the death using the InfoKeep rating; the ease of use according to the Ease rating (both measures used a five-point scale with a score <2 considered unsatisfactory); inter-observer agreement and the proportion of unexplained stillbirths. A randomly selected subset of 100 stillbirths was used to assess inter-observer agreement.

Results: InfoKeep scores were significantly different across the classifications (p < or = 0.01) due to low scores for Wigglesworth and Aberdeen. CODAC received the highest mean (SD) score of 3.40 (0.73) followed by PSANZ-PDC, ReCoDe and Tulip [2.77 (1.00), 2.36 (1.21), 1.92 (1.24) respectively]. Wigglesworth and Aberdeen resulted in a high proportion of unexplained stillbirths and CODAC and Tulip the lowest. While Ease scores were different (p < or = 0.01), all systems received satisfactory scores; CODAC received the highest score. Aberdeen and Wigglesworth showed poor agreement with kappas of 0.35 and 0.25 respectively. Tulip performed best with a kappa of 0.74. The remainder had good to fair agreement.

Conclusion: The Extended Wigglesworth and Amended Aberdeen systems cannot be recommended for classification of stillbirths. Overall, CODAC performed best with PSANZ-PDC and ReCoDe performing well. Tulip was shown to have the best agreement and a low proportion of unexplained stillbirths. The virtues of these systems need to be considered in the development of an international solution to classification of stillbirths. Further studies are required on the performance of classification systems in the context of developing countries. Suboptimal agreement highlights the importance of instituting measures to ensure consistency for any classification system.

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Figures

Figure 1

Figure 1

Retention of important information (InfoKeep) and ease of use (Ease) scores by classification systems. The extent to which the classification teams agreed that important information was conserved by the classification systems and was retrievable after classification was assessed using a scoring system (InfoKeep) consisting of a five point rating scale from 0 (Disagree) to 4 (Agree). Similarly, the extent to which the classification team agreed that it was easy to identify the relevant category in the classification system was assessed using the five point scoring system, Ease. Results represent the mean (± 1 SD) of the combined scores from each team for InfoKeep and Ease across the classifications systems.

Figure 2

Figure 2

InfoKeep scores by the main sources of important information. Prior to application of InfoKeep, the classification teams responded to the question as to whether important information to assist in understanding the circumstances of the death was identified in each case according to pre-defined information sources. Results represent the mean (± 1 SD) of the combined scores from each team for the most frequently reported information categories across the classifications system.

Figure 3

Figure 3

InfoKeep scores by stillbirth characteristics. Analyses were undertaken to determine InfoKeep scores according to important subgroups according to stillbirth characteristics. Results represent the mean (± 1 SD) of the combined scores for these subgroups from each team InfoKeep scores across the classification systems.

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References

    1. Stanton C, Lawn J, Rahman H, Wilczynska-Ketende K, Hill K. Stillbirth rates: delivering estimates in 190 countries. Lancet. 2006;367:1489–1494. doi: 10.1016/S0140-6736(06)68586-3. - DOI - PubMed
    1. Smith GCS, Fretts RC. Stillbirth. Lancet. 2007;370:1715–1725. doi: 10.1016/S0140-6736(07)61723-1. - DOI - PubMed
    1. Pattinson RC, Say L, Makin JD, Bastos MH. Critical incident audit and feedback to improve perinatal and maternal mortality and morbidity. Cochrane Database of Systematic Reviews. 2005. p. CD002961. - PMC - PubMed
    1. Gardosi J, Kady SM, McGeown P, Francis A, Tonks A. Classification of stillbirth by relevant condition at death (ReCoDe): population based cohort study. BMJ. 2005;331:1113–1117. doi: 10.1136/bmj.38629.587639.7C. - DOI - PMC - PubMed
    1. CESDI – Confidential Enquiry into Stillbirths and Deaths in Infancy . 8th Annual Report. London: Maternal and Child Health Research Consortium; 2001.

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