Value of an Endpoints Committee versus the use of nosologists for validating cause of death

Few studies have directly compared the use of nosologists versus other sources of mortality information deemed a gold standard, including the use of an Endpoints Committee (EC), which is commonly utilized in clinical studies.

We conducted a study of 421 participants in the Physicians' Health Study (PHS), known to have died of confirmed causes during the period of April 1982 to January 1988. Classification of cause of death was compared when coded by certified nosologists directly from the death certificate without the availability of full hospital and medical records versus determinations made by the PHS Endpoints Committee (EC).

The sensitivity of the nosologists, using the PHS EC as the gold standard, was 90% for total cardiovascular death, 89% for cancer and 89% for other deaths. However, when considering more specific causes of death, sensitivity for acute MI, sudden cardiac deaths and deaths from other cardiovascular causes were lower. Specificity was generally excellent for all endpoints, ranging from 90% to 100%. In analyses stratified by age, nosologists tended to overestimate the frequency of cardiovascular deaths in the elderly.

Mortality endpoints classified by trained nosologists versus the PHS EC indicate that nosologists can review death certificates to reasonably and quickly classify broad categories of causes of death in men, whereas an EC remains the preferable strategy when more specific causes of death must be ascertained by reviewing medical records and other accompanying information.