The International Classification of Diseases (ICD) is the standard diagnostic technique epidemiology, healthcare organization and disease diagnostics. The ICD allows you to analyze the health status of the population, organize monitoring of the incidence and spread of diseases, develop classifications of diseases and health disorders recorded in medical and civil documentary sources (medical records, death certificates).
Ability to store and retrieve diagnostic information within the ICD for medical, epidemiological, and quality assurance purposes medical services, serves as the basis for compiling mortality and morbidity statistics for WHO member countries. Keeping statistics is of particular importance for making decisions about financing and resource allocation in the health system.
The ICD, 10th revision, was approved at the 43rd World Health Assembly in May 1990 and has been in use in WHO member states since 1994. The 11th revision procedure will be completed in 2015.
The International Classification of Diseases and accompanying materials are available for download in various formats (including ClaML) in a special section of our website. To gain access to the files, you must register and accept the terms of the license agreement.
Electronic training manual according to ICD-10 can be used both for self-study, and for working in a study group. The modular structure of the manual allows, if necessary, to build educational process depending on the needs of the students.
The tutorial is available in two versions.
List of ICD-10 classes
ICD-10- International Classification of Diseases, 10th revision. As of January 2007, this is the generally accepted classification for coding medical diagnoses, developed by the World Health Organization. ICD-10 consists of 21 sections, each of which contains subsections with codes for diseases and conditions.
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International Statistical Classification of Diseases and Related Health Problems - a document used as a guide statistical And classification basis in healthcare. Reviewed periodically (every ten years) under the guidance of WHO. ICD is normative document ensuring unity methodological approaches and international comparability materials.
Currently, the International Classification of Diseases, Tenth Revision (ICD-10, ICD-10) is in force. In Russia, health authorities and institutions transitioned statistical accounting to ICD-10 in 1999
Goals, objectives and scope of the ICD.
The purpose of the ICD is to create conditions for the systematic recording, analysis, interpretation and comparison of mortality and morbidity data obtained in different countries or regions and at different times. The ICD is used to convert verbal diagnoses of diseases and other health problems into alphanumeric codes that make data easy to store, retrieve, and analyze.
The ICD has become the international standard diagnostic classification for all general epidemiological purposes and many health care management purposes. They include an analysis of the overall health situation of population groups, as well as calculations of the incidence and prevalence of diseases and other health problems in their relationship to various factors.
The International Conference on the Tenth Revision of the International Classification of Diseases was held by the World Health Organization in Geneva from September 25 to October 2, 1989. The main innovation in the Tenth Revision is the use of an alphanumeric coding system, which presupposes the presence of one letter in a four-digit rubric followed by three numbers, which made it possible to more than double the size of the coding structure. Introducing letters or groups of letters into rubrics allows up to 100 three-character categories to be coded in each class.
An important innovation was the inclusion at the end of some classes of a list of rubrics for disorders arising after medical procedures. These categories indicated serious conditions that occurred after various interventions, such as endocrine and metabolic disorders after organ removal or other pathological conditions such as dumping syndrome after gastric surgery.
Structure, principles of construction
In contrast to the international nomenclature of diseases, the statistical classification (ICD-10) is based on the hierarchical principle of grouping diseases by assigning each nosology (or disorder) a statistical code with a letter of the English alphabet as the first character and numbers in the second, third and fourth characters of the code.
The first three characters of the code constitute a category that generally identifies a disease of particular public health significance or high prevalence. The headings form the “core” of the classification and at their level, data is submitted to WHO on the causes of death and the prevalence of a number of diseases, in order to conduct basic international comparisons. The fourth character of the statistical code follows the decimal point, detailing the content of the rubric. The four-digit code is defined as a subcategory. Four-digit subcategories form an integral part of the ICD and at their level, causes of death and morbidity are coded for submission to state statistics bodies, for interregional comparisons and in-depth statistical developments in specific areas of medicine.
ICD-10 consists of three volumes.
Volume 1 of the classification includes a complete list of headings and subcategories, code numbers of which range from A00.0 to Z99.9. The diseases included in it are divided into 21 classes, each of which in turn is subdivided into “blocks” of homogeneous three-digit headings, interconnected by common characteristics. The selected blocks of rubrics give an idea of the priorities of individual groups of diseases in assessments of public health and health care activities. The hierarchical principle of constructing a classification (class, blocks, headings, subcategories) makes it possible to carry out statistical development at various levels of detail of the collected data:
Class II - Neoplasms
Class III - Diseases of the blood, hematopoietic organs and certain disorders involving the immune mechanism
Class IV - Diseases endocrine system, eating disorders and metabolic disorders
Class V - Mental and behavioral disorders
Class VI - Diseases of the nervous system
Class VII - Diseases of the eye and its adnexa
Class VIII - Diseases of the ear and mastoid process
Class IX - Diseases of the circulatory system
Class X - Respiratory diseases
Class XI - Diseases of the digestive system
Class XII - Diseases of the skin and subcutaneous tissue
Class XIII - Diseases of the musculoskeletal system and connective tissue
Class XIV - Diseases of the genitourinary system
Class XV - Pregnancy, childbirth and the puerperium
Class XVI - Selected conditions arising in the perinatal period
Class XVII - Congenital anomalies [blood defects], deformities and chromosomal disorders
Class XVIII - Symptoms, signs and abnormalities identified during clinical and laboratory research, not classified elsewhere
Class XIX - Injuries, poisoning and some other consequences of external causes
Class XX - External reasons morbidity and mortality
Class XXI - Factors influencing the health status of the population and visits to health care institutions
Volume 2 of the classification provides guidance on the use of ICD-10.
Volume 3 includes an Alphabetical Index to full list headings (volume 1) and is a significant addition to it, as it contains large number diagnoses and less specified conditions presented in Volume 1. Thus, the Alphabetical Index includes almost all diagnostic terms currently used in medical practice.
As mentioned above, the core of the classification is volume 1, which in the tenth revision included 21 classes. The first seventeen of them (A00-Q99) relate to diseases and other pathological conditions. Class 18 (R00-R99) covers symptoms, signs and abnormalities identified by clinical and laboratory tests, as well as ill-defined conditions for which there is no diagnosis that could be attributed to any of the first seventeen classes. This class also includes a block of rubrics (R95-R99) intended for coding ill-defined and unknown causes of death.
Grade 19 (S00-T98) includes rubrics identifying various types injuries, poisonings and other consequences of external causes, including headings designed to identify a number of complications of surgical and therapeutic interventions.
The 20th and 21st classes, which were previously considered as an addition to the main classification, now with the introduction of the tenth revision received equal status with other classes.
Class 20 “External causes of morbidity and mortality” (V01-Y98) is primarily used to classify incidents (conditions and places of their occurrence, circumstances) that caused injuries, poisonings and other adverse effects classified in the nineteenth class, and in cases of death from these conditions in statistical development, preference should be given to the headings of the twentieth grade.
Class 21 (Z00-Z99) makes it possible to take into account and classify factors that influence health and encourage a person who is not necessarily sick to contact a health care institution (for example, for preventive vaccination or examination, obtaining advice on an existing problem that affects health, etc.).
Question No. 27.
Population morbidity: definition, objectives and methods of study. Primary incidence and prevalence of diseases:
definition, methodology for calculating indicators, their levels in Russia.
Definition, objectives of study, methods of morbidity
Morbidity- one of the indicators of population health. Key population health indicators:
Medical and demographic.
Morbidity.
Disability.
Morbidity is one of the most important criteria characterizing the health of the population. Under morbidity refers to data on the prevalence, structure and dynamics of various diseases registered among the population as a whole or in its individual groups. Types of morbidity:
Morbidity according to primary appeal data, which includes general morbidity, infectious morbidity, hospital morbidity with temporary disability, the most important non-epidemic diseases (tuberculosis, syphilis).
Morbidity according to medical examinations and clinical observation.
Morbidity according to causes of death (data are taken from the registry office documents - death certificates).
If you need to study the incidence of illness with temporary disability, you need to take a certificate of incapacity for work, which is kept in the accounting department).
To study the general morbidity, a medical card and statistics are taken. ticket.
To study the incidence of tuberculosis, syphilis, and gonorrhea, a document is taken about the most important non-epidemic disease.
Each type of morbidity has an accounting and reporting form. Infectious hospital morbidity is the most important non-epidemic morbidity, morbidity with temporary disability are components of the general morbidity. The study of only one of the listed species is only part of the information on overall morbidity. The requirements for separate study of these types of morbidity are explained by certain reasons:
infectious morbidity - requires rapid implementation of anti-epidemic measures;
hospital morbidity - information about it is used to plan bed capacity;
morbidity with temporary disability - determines economic costs;
the most important non-epidemic morbidity - provides information about the prevalence of socially determined diseases.
Tasks
When studying morbidity and obtaining information about the health of the population, it is possible to determine:
risk factors
justify health-improving measures
evaluate the effectiveness of implemented measures
for operational management of the activities of healthcare institutions
for current and forward planning personnel
to improve the structure of the health service as a whole and individual institutions
Methods for studying morbidity:
The study of morbidity is carried out according to the generally accepted scheme of statistical research and a strict sequence of stages. Stages:
1. collection of information
2. grouping and summary of materials and their encryption
3. counting processing
4. analysis of materials and their design (conclusions, recommendations).
When studying morbidity in connection with the state of the environment, a targeted study of environmental factors and an in-depth analysis of morbidity are necessary.
Sources of information on morbidity:
1. medical information about the appeal for medical care
2. medical data examinations
3. materials on causes of death
Request for medical care help is absolute number patients who applied to medical institutions for the first time in a calendar year due to a disease. All initial and repeat requests are characterized by attendance.
To assess population morbidity, coefficients are used, calculated as the ratio of the number of diseases to the number of population groups and recalculated to the standard (per 100 1000 10000 people). These coefficients allow us to estimate the probability of the risk of any disease occurring in the population. To obtain approximate ideas about the morbidity of the population, the calculation of general coefficients (extensive intensive) is provided. To identify cause-and-effect relationships, special coefficients are needed, that is, taking into account gender, profession, etc.
Primary morbidity and prevalence of diseases: definition, methodology for calculating indicators, their levels in Russia.
Morbidity rates. There are:
Primary or actual morbidity;
Widespread or painful;
Frequency of diseases detected during medical examinations or pathological involvement.
Definitions of primary incidence and prevalence:
Primary incidence- this is the number of diseases diagnosed for the first time in life within 1 year. All acute diseases and chronic diseases diagnosed for the first time in life are taken into account upon first visit to the medical institution(relapses of chronic pathology occurring within a year are not taken into account).
Morbidity or prevalence of diseases- this is the totality of all acute and all chronic diseases registered in a given calendar year. Morbidity is always higher than the level of morbidity itself. The morbidity indicator, in contrast to morbidity, indicates dynamic processes occurring in the health of the population and is more preferable for identifying causal relationships. The morbidity indicator gives an idea of both new cases of the disease and previously diagnosed cases, but with an exacerbation of which the population turned to us in a given calendar year.
Pathological affection- the totality of all diseases and pathological conditions identified during comprehensive medical examinations. This indicator gives an idea of the population of patients registered on specific date. Mainly highlighted chronic pathology and in most cases of this disease with which the population did not go to medical institutions.
Methods for studying morbidity.Methodology for calculating indicators, their levels in Russia.
Solid;
Selective
Solid - acceptable for operational purposes. Selective - used to identify the relationship between disease incidence and environmental factors. The sampling method was used during census years. An example of this is the study of morbidity in individual territories. The choice of method for studying the morbidity of the population in a particular territory or its individual groups is determined by the purpose and objectives of the study. Approximate information about the levels, structure and dynamics of morbidity can be obtained from the reports of treatment and preventive institutions and reports from the central administration using the continuous method.
Identification of patterns, morbidity, and connections is possible only with the selective method by copying passport and medical data from primary accounting documents onto a statistical card.
When assessing the level, structure and dynamics of morbidity among the population and its individual groups, it is recommended to compare with indicators for the Russian Federation, city, district, region. The unit of observation when studying general morbidity is the patient’s initial visit in the current calendar year regarding the disease. The main accounting documents for studying general morbidity are: a medical card and a statistical certificate for a specified diagnosis. The overall incidence is calculated per 1000, 10,000 population. In the structure of general morbidity in Russia, the first place is occupied by diseases of the respiratory system, diseases of the nervous system and sensory organs are in second place, and diseases of the circulatory system are in third place. Among children (0 -14) years old, infectious diseases occupy second place in the structure of overall morbidity, the share of which is 9.7%.
The incidence of infectious diseases is studied by recording each case of an infectious disease or suspicion of an infectious disease, for which an accounting document is issued - an emergency notification of an infectious disease. An emergency notification is sent within 12 hours to the center of state sanitary and epidemiological supervision and registered in a log infectious diseases. Based on the entries in this journal, a report is compiled on the movement of infectious diseases for each month, quarter, half-year, and year. The unit of observation when studying infectious morbidity is a case of infectious morbidity. Calculated for 10,000, 100,000 people. The study of infectious morbidity includes identifying the source of infection, analyzing seasonality, and analyzing the effectiveness of anti-epidemic measures. In the Russian Federation, the highest morbidity rate is in the ARVI group, which accounts for 87% of the total infectious morbidity rate. The incidence of influenza per 100,000 population is 3,721, acute upper respiratory tract infection is 20. In recent years, vaccination recommended by WHO has been used for mass prevention. High level OKI. In recent years, more than 1 million 100 thousand have suffered from dysentery, typhoid fever, salmonellosis. About 60% are children under 14 years of age. Unfavorable areas for dysentery: Korelia, Komi, Arkhangelsk, Kostroma, Penza regions. Calculation of the incidence of hepatitis, including hepatitis B and C. There is a normalization of the situation regarding cholera, including imported ones. The incidence of measles increased by 4 times, whooping cough by 63%. Diphtheria is epidemic in a number of regions. Overall, the incidence of diphtheria increased 4 times. The highest incidence rate is in St. Petersburg (more than 5 times higher than in Russia).
The most important non-epidemic diseases: tuberculosis, sexually transmitted diseases, mental illness, mycoses, malignant neoplasms, cardiovascular diseases. An accounting document is a notification about the most important non-epidemic diseases. The unit of observation for these diseases is the sick person. Morbidity records are kept in dispensaries. The incidence of tuberculosis in Russia increased by 25%, among children by 18%. The highest incidence rate is observed in Komi, Dagestan, Volgograd region, and Moscow. This situation is associated with large emigration of the population, with a decrease in the quality of nutrition, with a decrease in the number of patients open form tuberculosis. The incidence of syphilis in Russia increased by 2.6 times, and gonorrhea by 37.4%. The incidence of sexually transmitted diseases in children and adolescents has increased. This happens due to negative social phenomena in society, the lack of work on the moral education of children and adolescents.
Morbidity with temporary disability. The unit of observation is each case of temporary disability. An accounting document - a certificate of incapacity for work (has not only medical and statistical, but also legal financial significance). Recalculation per 100 employees.
Key indicators:
1. Morbidity structure in the case.
2. Morbidity structure in calendar days.
3. Number of cases per 100 workers.
4. Number of calendar days per 100 workers.
5. Average duration of one case of disease.
Average level in Russia:
80-120 cases per 100 workers
800-1200 calendar days per 100 workers.
The incidence rate is currently decreasing. Reporting document - Form 16 VN. Recently, for an in-depth methodology, an in-depth analysis technique has been used (not for everyone, but for those who have worked in the institution for at least 1 year). All 5 indicators are studied, but taking into account length of service, gender, and professional experience, and risk groups are determined.
In an in-depth study of risk groups:
1. Frequently ill: 4 times or more with etiologically related diseases and 6 times or more with etiologically unrelated diseases.
2. Long-term ill patients: in a calendar year, 40 days or more of etiologically related diseases and 60 days or more of etiologically unrelated diseases.
3. Frequently sick for a long time: 4 times or more in a calendar year and 40 days or more with etiologically related diseases, 6 times or more and 60 days or more with etiologically unrelated diseases.
With an in-depth study, a health index is calculated - this is the percentage of people who have never been sick this year (normally 50-60%).
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The International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) is built on an alphanumeric basis and contains 21 classes of diseases. ICD-10 was adopted by the 43rd World Health Assembly, in Geneva (September 25 - October 2, 1989). The World Health Organization (WHO) recommended the introduction of ICD-10 from 01/01/1993.
By Order of the Ministry of Health of the Russian Federation dated May 27, 1997 No. 170“On the transition of healthcare authorities and institutions of the Russian Federation to ICD-10” the transition date was set as 01/01/1998, but in most regions of the Russian Federation it was postponed for a year. By Order of the Ministry of Health of the Russian Federation dated August 7, 1998 No. 241“On the improvement of medical documentation certifying cases of birth and death in connection with the transition to ICD-X”, from 01/01/1999, a new form of medical death certificate was introduced in accordance with the requirements of ICD-10.
Thus, the pathologist is entrusted with the functions of encrypting (coding) the causes of death in cases of pathological autopsies.
Execution Order of the Ministry of Health of the Russian Federation dated December 4, 1996 No. 398“On coding (encryption) of causes of death in medical documentation” is associated with the transfer of functions for coding causes of death in order to improve the quality of filling out medical death certificates to the pathological service. This work should be carried out under the control of the heads of territorial health authorities of the constituent entities of the Russian Federation.
ICD-10 contains the following new provisions:
- Specifically grouped classes of diseases have priority over classes, the construction of which is based on pathological changes in individual organs and systems. Among these specifically grouped classes, the classes “Pregnancy, childbirth and the postpartum period”, “Certain conditions arising in the perinatal period” take precedence over others.
The notes in the disease class lists apply to all uses of the ICD. Notes that relate to morbidity only or mortality only are provided in the special notes accompanying the morbidity or mortality coding rules.
Iatrogenic complications, if it is necessary to code them (in cases where they are interpreted as the original cause of death), are encrypted with class XIX codes - “Injuries, poisoning and some other consequences of external causes.”
- On medical death certificates, only the underlying cause of death is encrypted (encoded), and not direct, as is still often the case in erroneously issued medical reports (for example, “acute cardiovascular failure” instead of the original cause of death). Article 5 of the Nomenclature Regulations relating to disease and causes of death states: “WHO Member States shall approve a form of medical certificate of cause of death that allows the disease or injury causing or contributing to death to be recorded, clearly indicating the underlying cause. "
- Not all concepts and codes specified in ICD-10 can be used to formulate and encrypt the original cause of death, i.e. the underlying disease in the final clinical and pathological diagnoses. This is due to the fact that in ICD-10 includes not only nosological forms, but also syndromes, symptoms, pathological conditions, injuries, conditions of injury and trauma. Many of them are intended for coding the reasons for seeking medical help, for statistical analysis of pathological conditions that were the reasons for hospitalization, when the diagnosis of the underlying disease is not yet clear.
- When encoding the causes of death in pathoanatomical practice, they are not used last sign“.9”, since the possibilities of autopsy make it possible to clarify the nature of the disease. The “-” sign indicates that there is a fourth character in the ICD and should be used. Round and square brackets enclose additional terms, synonyms, and clarifications that allow you to more accurately select the desired code. The conjunction "and" means "or". In all subheadings, the fourth character “.8” means “other conditions not specified above,” and the fourth character “.9” means “unspecified information (disease, syndrome, etc.).”
- In case of exacerbation of a chronic disease, unless otherwise provided by a special ICD code, the acute form of the disease is encrypted. For example, with exacerbation of chronic cholecystitis, acute cholecystitis is coded.
ICD-O code numbers (oncological classification) consist of 5 digits: the first 4 determine the histological type of the neoplasm, and the 5th digit, which follows the dividing line or without it, indicates its nature in terms of the course of the disease: /0 - benign neoplasm, /1 – neoplasm that is not defined as benign or malignant, borderline malignancy, excluding ovarian cystadenomas, /2 – cancer (intraepithelial, non-infiltrative, non-invasive), /3 – malignant neoplasm, primary localization, /6 – metastatic malignant neoplasm, /9 – malignant neoplasm that is not defined as primary or metastatic.
Thus, there are 10 characters (digits) necessary for complete identification of the topography (4 characters), morphological type (4 characters), nature of the tumor (1 character) and histological grading or degree of differentiation of the neoplasm or its equivalent for leukemias and lymphomas (1 character ).
A number of other innovations compared to ICD-9 are noteworthy. Thus, in class 1X “Diseases of the circulatory system,” instead of the term “hypertension,” the group concept “hypertensive disease” is used. In this case, forms with congestive heart failure, with renal failure, with heart and kidney failure are distinguished. Cases (hereinafter referred to as independent nosological units) involving the arteries of the heart, brain, limbs, etc. are excluded from this section.
Coronary heart disease, as a group (generic) concept (not a nosological unit), includes a number of nosological forms, in particular, variants of angina pectoris, myocardial infarction, cardiosclerosis, etc. Presence hypertension in such patients it is recommended to mark it with a second code as a background disease.
Unfortunately, some terms appeared in ICD-10, literally translated into Russian, that do not correspond to modern concepts of domestic medicine, for example, “myocardial degeneration,” which is also important to consider when choosing codes that can be used in the practice of a pathologist.
Iatrogenic pathology deserves special consideration, which, in cases where iatrogenicity is elevated to the rank of the main disease, is often encrypted with a medical intervention code. The formulation of the diagnosis (how to interpret iatrogenicity - as the main disease or complication) depends in each specific case on the nature of the initial and immediate causes of death. ICD-10 clearly defines that iatrogenic fatal complications are indicated as the initial cause of death (the underlying disease) in case of erroneous overdose, incorrect prescription of a drug, unprofessional (with errors, not according to indications, with underestimation of the patient’s characteristics) diagnostic or therapeutic event. Other iatrogenic, even fatal complications that arose when medical care was provided correctly and according to indications should be considered as complications of the underlying disease (with the exception of anaphylactic shock and some other complications that are traditionally presented as the underlying disease).
Thus, in accordance with the requirements of ICD-10, underlying disease - it is a nosological unit that should be used to analyze single-cause morbidity and mortality. This is the illness or injury that was treated or evaluated during the last episode of medical care or that was the cause of death. The underlying disease is defined as one that has been diagnosed at the end of the episode of care , for which mainly therapeutic or diagnostic procedures were carried out. If there is more than one such disease, choose the one that had higher value in thanatogenesis, is considered more severe or socially significant, and also which accounted for the largest part of the resources used, which corresponded to the profile medical institution or its branches.
It is not allowed to indicate as the main disease those nosological units that were diagnosed in earlier episodes of the diagnostic and treatment process, but which did not have an impact on current episode, were not the cause of death. As rightly noted in ICD-10, limiting the analysis to a single nosological unit for each episode entails the loss of some of the available information. Therefore, ICD-10 recommends that whenever possible, coding and analysis of morbidity by multiple causes (double and multiple coding) be performed to complement routine data. This should be done, for example, in accordance with the design rules of the so-called. combined underlying disease.
When formulating a final clinical diagnosis, it is necessary to identify the disease (injury) that itself, or through complications associated with it, led the patient to death (but may not have been the reason for the patient seeking medical help or even the reason for medical measures). The same requirement applies to pathological diagnosis, since The main task of a pathological autopsy is to determine the initial cause of death (main disease, injury) and the immediate cause of death (fatal complication).
The rubric of the final clinical and pathological diagnoses regarding the underlying disease should not include diseases for which diagnostic and therapeutic interventions were not undertaken in this episode (unless, of course, this particular case is a discrepancy in diagnoses). For example, stenosing atherosclerosis without an episode of diagnostic or therapeutic angiography or surgical intervention and in the presence of ischemic damage to a specific organ, it cannot be the underlying disease.
In order to streamline the recording of causes of death, the 20th World Health Assembly defined the causes of death that should be recorded on the medical death certificate as “all those diseases, pathological conditions or injuries that led to or contributed to death, as well as the circumstances of the accident or the act of violence that caused any such injury.” This definition was formulated to ensure that all death-related information is recorded. so that the person filling out the medical death certificate does not select certain conditions and exclude others when recording only at his own discretion, as is often, unfortunately, practiced to this day.
It should be noted that this definition does not provide for the inclusion in the medical death certificate of symptoms and phenomena accompanying the onset of death (mechanism of death), such as heart failure, asthenia, intoxication, etc.
The problem of classifying causes of death for vital statistics is solved relatively simply when there is only one nosological unit that was the original cause of death. However, in many cases (according to the Moscow city pathological service - in 60-70% of cases) death is caused by two or more diseases. This problem is solved by using the diagnosis of “combined underlying disease.” In these cases, in demographic statistics it has become a traditional practice to select for statistical development only one (first) of the nosological units indicated in the combined main disease - the causes of death. This cause has been labeled differently in the past: “cause of death”, “ primary cause death”, “principal cause of death”, “underlying or main cause of death”. To unify the terminology and methodology for choosing the cause of death when carrying out statistical developments, at the International Conference on the 6th revision of the ICD, an agreement was reached on the use of the term in medical statistical documentation “original cause of death.” According to ICD-10, causes of death that must be included in the death certificate and other medical documentation, in accordance with the definition given by the 20th World Health Assembly, are all those diseases, pathological conditions or injuries that led to death or contributed to its occurrence, as well as the circumstances of the accident or act of violence that caused such injuries.
The underlying cause of death must be considered to be: a) the disease or injury that caused the successive series of disease processes leading directly to death, or b) the circumstances of the accident or act of violence that caused the fatal injury.
