Alphabet Soup

The answer to the PPQ (Practice Pearls Quizlet) will be revealed. But first things first.

A surefire way to trigger a query from vital statistics officials is to commit one of several errors. One error is the use of medical abbreviations or acronyms and shorthand in the cause-of-death statement. Medical abbreviations while convenient are not necessarily universally understood by others less familiar with their many contextual meanings. So one way to avoid the inconvenience of the query, is to avoid the use of abbreviations, acronyms, and shorthand.

Consider the following possible translations for common medical abbreviations:

AMI: Acute Myocardial Infarct(-ion), Acute Mesenteric Ischemia

CHD: Coronary Heart Disease, Congenital Heart Disease, Chronic (Ischemic) Heart Disease

HLD: Hyperlipidemia, Hypersensitivity Lung Disease, Herniated Lumbar Disc

PE: Pulmonary Embolism, Pre-Eclampsia, Pleural Effusion

TAH: Total Abdominal Hysterectomy, Transfusion Associated Hepatitis

Each one of these conditions, if listed as the underlying cause of death, would be coded differently by nosologists, ultimately affecting mortality statistics. Many of them represent conditions with lethal potential. Others are not necessarily lethal if well-controlled or resolved.  Many of them also lack etiologic specificity and would not be appropriate to list as an underlying cause of death. Some of them may be associated with non-natural underlying causes which would require reporting to the Medical Examiner or Coroner. Still others may or may not be clinically significant enough to be listed in Part II. Indeed, nosologists are medical classification specialists, but they are not mind readers and they are not physicians.

…and not to omit: DVT– can’t quibble much with this one; Deep Vein Thrombosis especially in conjunction with Pulmonary Embolism or more specifically Pulmonary Arterial Thromboembolism would be the obvious choice. CHF– most would interpret as Congestive Heart Failure but Congenital Hepatic Fibrosis could apply in the right clinical context. Not much room to misinterpret NIDDM and CABG.

***And finally, the answer/explanation to the Inaugural PPQ from May 21st is: FALSE. Abbreviations are not acceptable.***

To illustrate, the sample presented in May 21st’s PPQ could be translated as:

Part I.

 

A. Pre-eclampsia/Deep Vein Thrombosis

Approximate interval: Onset to death

Days

Due to (or as a consequence of):

B. Acute Mesenteric Ischemia with Congenital Hepatic Fibrosis

 

Years

Due to (or as a consequence of):

C. Congenital Heart Disease

 

Years

Due to (or as a consequence of):

D. Hypersensitivity Lung Disease

 

Years

Part II. Other significant conditions contributing to death but not resulting in the underlying cause given in Part I: Non-Insulin Dependent Diabetes Mellitus, status post Coronary Artery Bypass Grafting times 3, status post Transfusion Associated Hepatitis
Manner of Death

Natural

 

Aside from the fact this statement makes absolutely no sense, additional errors happen to be represented and are also ones that should be avoided when formulating a cause of death.

Most likely, the intended translation was as follows:

Part I.

 

 

A. Pulmonary Embolism arising from Deep Venous Thrombosis

Approximate interval: Onset to death

Days

 

Due to (or as a consequence of):

B. Acute Myocardial Infarct with Congestive Heart Failure

 

*Years

Due to (or as a consequence of):

C. *Coronary Heart Disease

 

Years

Due to (or as a consequence of):

D. Hyperlipidemia

 

Years

Part II. Other significant conditions contributing to death but not resulting in the underlying cause given in Part I: Non-Insulin Dependent Diabetes Mellitus, status post Coronary Artery Bypass Grafting times 3, status post Total Abdominal Hysterectomy
Manner of Death

Natural

 

 

*Some tweaking of this statement may still be in order. For example, the time interval for line ‘b.’ makes more medical sense as “days” rather than “years”. For line ‘c’, Coronary Artery Disease or Atherosclerotic Coronary Artery Disease would be more specific. Finally, inclusion of Total Abdominal Hysterectomy in Part II is unnecessary.

For more examples of disastrous cause-of-death statements and how to avoid being caught in a query quagmire, consult Chapters 3 and 8 and take the Self-Assessment Test found in Essentials of Death Reporting and Death Certification-Practical Applications for the Clinical Practitioner available on Amazon.com .

For a direct link to this book, click on: https://www.amazon.com/Essentials-Death-Reporting-Certification-Applications/dp/0998533408/ref=sr_1_1?ie=UTF8&qid=1

 

Stay tuned for future PPQs and your next dose of Practice Pearls!

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