Performance of the tariff method and physicians in determining stroke as the cause of deaths using verbal autopsy in areas with a limited number of physicians: cases in Indonesia
Abstract
Background: Physician-certified verbal autopsy (PCVA) is the primary method used to determine the cause of death in Indonesia, although it is very costly and problematic to use in areas where physicians are not widely available with most deaths occur at home. The Tariff method has been piloted to obtain an alternative approach that does not require a physician to determine the cause of death. This validation study presents how the Tariff captures the correctness and distinctiveness of stroke symptoms to the PCVA.
Methods: Medical records of 298 adult deaths that occured in four teaching hospitals in the Jakarta from January 1, 2015 to March 2017 were collected prospectively. Verbal Autopsy (VA) was applied using the 2014 WHO instrument diagnosed by a trained physician (PCVA) and by Tariff method. The validity of the VA was assessed by comparing the PCVA diagnoses with the Tariff diagnoses, referring to the best standard.
Results. Sensitivity, specificity and positive predictive value (PPV) of VAs using physician’s diagnosis (PCVA) for stroke were 73.9%, 73.5% and 93.4% respectively. The corresponding sensitivity, specificity and positive predictive value (PPV) of VAs diagnosed by the Tariff method were 75%, 61% and 91%. The negative predictive values (NPV) of both techniques were low, 35.6% and 32.6% respectively.
Conclusion: The performance of the Tariff method for stroke was almost similar with PCVA, and with a narrower variation, or more consistent than PCVA. Therefore, the Tariff method is a potential alternative to be used on a large scale, because the difficult geographical conditions where physician are not widely available for causes of deaths with distinct signs and symptoms.
Keywords: verbal autopsy, sensitivity, specificity, determining cause of death, physician, tariff method
Abstrak
Latar Belakang: Autopsi verbal yang disertifikasi oleh dokter (PCVA) merupakan metode utama yang digunakan untuk memastikan penyebab kematian di Indonesia. Meskipun sangat mahal dan bermasalah untuk digunakan di daerah di mana dokter tidak banyak tersedia dan sebagian besar kematian terjadi di rumah. Metode Tarif telah diujicobakan untuk mendapatkan pendekatan alternatif yang tidak memerlukan dokter untuk menentukan penyebab kematian. Studi validasi ini menyajikan bagaimana Tarif menangkap kebenaran dan kekhasan gejala stroke dibandingkan dengan PCVA.
Metode: Rekam medis dari 298 kematian orang dewasa yang terjadi di empat rumah sakit studi di wilayah Jakarta pada 1 Januari 2015 hingga Maret 2017 dikumpulkan secara prospektif. Autopsi verbal (AV) dilakukan dengan menggunakan instrumen WHO 2014 yang didiagnosis oleh dokter terlatih (PCVA) dan metode Tarif. Validitas AV dinilai dengan membandingkan diagnosis PCVA dengan diagnosis metode Tarif, mengacu pada baku mutu.
Hasil. Sensitivitas, spesifisitas dan nilai prediksi positif (PPV) dari AV dengan diagnosis dokter (PCVA) untuk stroke adalah 73,9%, 73,5% dan 93,4%. Sensitivitas, spesifisitas, dan nilai prediksi positif (PPV) yang sesuai dari AV yang didiagnosis dengan metode Tariff adalah 75%, 61% dan 91%. Nilai prediksi negatif (NPV) dari kedua teknik itu rendah, masing-masing 35,6% dan 32,6%.
Kesimpulan: Untuk stroke, kinerja metode Tarif hampir sama dengan PCVA, dan dengan variasi yang lebih sempit, atau lebih konsisten dibandingkan PCVA. Oleh karena itu, untuk penyebab kematian dengan tanda dan gejala yang berbeda, metode Tarif merupakan alternatif potensial untuk digunakan dalam skala besar, di Indonesia dimana banyak wilayah dengan geografis sulit dan dokter tidak selalu tersedia.
Kata kunci: autopsi verbal, sensitifitas, spesifisitas, penentuan penyebab kematian, dokter, metode tariff
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