병원 도착 전 사망 환자의 사인기재에 관한 고찰 = Survey of the Causes of Death on the Death Certificates of DOA Patients

다국어 초록 (Multilingual Abstract)

Background: To the emergency physician, issuing a death certificate is becoming a burden as the DOAs(Deaths on Arrival) have increased in recent years. We analyzed the agreement on the causes of death issued by emergency physicians and attempted to find out whether emergency physicians complied with the guidelines for issuing death certificates.
Material & Method: A survey questionnaire containing twelve pre-selected DOA cases which were supplemented with relevant past medical history and physical examination was used. The cases, with varying causes of death, were chosen from the medical records of DOA patients who presented to the emergency department at Severance Hospital, Yonsei University College of Medicine, from January 1997 to December 2000. The questionnaires were sent to 60 emergency physicians(22 specialists and 38 residents) at 22 university-affiliated teaching hospitals and 2 general hospitals across the nation. They were asked to identify the most probable direct cause of death for each of the 12 cases. The same questionnaire was sent to medical examiners at the National Institute of Scientific Investigation and to a Korean emergency physician at Albert Einstein College of Medicine in New York, USA. We also included an open question about the optimal age for the use of 'senility' as a cause of death.
Results: All 60 emergency physicians responded to the survey. The average number of causes of death per case was 9.7(7∼ 14). The range of concordance of causes of death was 23.3% to 66.6%. Out of a total of 720 causes of death given by the emergency physicians,35(4.9%) failed to adhere to the death certification guidelines, Also, 210 causes of death were not listed in the Korean classification of standard causes of death. Interestingly, the medical examiner answered 'unknown etiology' and the emergency physician in the USA answered 'cardiopulmonary arrest' or 'respiratory arrest' in most cases. Regarding 'senility' as a cause of death, 22 physicians(36.7%) thought the optimal age was over 80 years.
Conclusion: A significant lack of agreement exists in determining the cause of death for the DOA patients arriving at emergency departments, Therefore, an all-out effort is essential to find ways to improve and resolve this situation. As the death certificate is a legal document and a basis for vital statistics, emergency physician should seek a rational consensus to improve and resolve these inconsistencies.

목차 (Table of Contents)

• Ⅰ.서론
• Ⅱ.대상과 방법
• Ⅲ.결과
• 1.예제별 사인의 일치도(표 2)
• 2."작성지침"의 사인기재 원칙과의 부합정도
• 3."분류표"의 질병명에 기준한 기재오류
• 4.사인으로 '노쇠'의 사용이 가능한 적정 연령
• 5.국립 과학수사연구소 법의관의 답변
• 6.Jacobi 병원 응급의학과 의사의 답변
• Ⅳ.고찰
• Ⅴ.결론