An evaluation of classification systems for stillbirth

Flenady, Vicki, Froen, J. Frederik, Pinar, Halit, Torabi, Rozbeh, Saastad, Eli, Guyon, Grace, Russell, Laurie, Charles, Adrian, Harrison, Catherine, Chauke, Lawrence, Pattinson, Robert, Koshy, Rachel, Bahrin, Safiah, Gardener, Glenn, Day, Katie, Petersson, Karin, Gordon, Adrienne and Gilshenan, Kristen (2009) An evaluation of classification systems for stillbirth. BMC Pregnancy and Childbirth, 9 . doi:10.1186/1471-2393-9-24

Author Flenady, Vicki
Froen, J. Frederik
Pinar, Halit
Torabi, Rozbeh
Saastad, Eli
Guyon, Grace
Russell, Laurie
Charles, Adrian
Harrison, Catherine
Chauke, Lawrence
Pattinson, Robert
Koshy, Rachel
Bahrin, Safiah
Gardener, Glenn
Day, Katie
Petersson, Karin
Gordon, Adrienne
Gilshenan, Kristen
Title An evaluation of classification systems for stillbirth
Journal name BMC Pregnancy and Childbirth   Check publisher's open access policy
ISSN 1471-2393
Publication date 2009-06-19
Sub-type Article (original research)
DOI 10.1186/1471-2393-9-24
Open Access Status DOI
Volume 9
Total pages 13
Place of publication London, United Kingdom
Publisher BioMed Central
Formatted 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 ≤ 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 ≤ 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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Article # 24

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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