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An evaluation of classification systems for stillbirth
Vicki Flenady1, J Frederik Frøen, Halit Pinar
1Mater Mothers' Research Centre, Mater Health Services, Brisbane, Australia. Vicki.flenady@mater.org.au
BMC Pregnancy and Childbirth
|June 23, 2009
Summary
Six stillbirth classification systems were evaluated for clinical practice and prevention. CODAC and Tulip demonstrated superior performance in data retention and reducing unexplained stillbirths, informing international standards.
Area of Science:
- Perinatal Medicine
- Public Health
- Medical Informatics
Background:
- Stillbirth audit and classification are crucial for prevention.
- Existing systems like ICD have limitations, leading to diverse classification approaches.
- An international standard is needed for consistent stillbirth classification.
Purpose of the Study:
- To assess the performance of six contemporary stillbirth classification systems.
- To identify strengths and weaknesses of each system for informing international development.
- To evaluate data retention, ease of use, agreement, and unexplained stillbirth rates.
Main Methods:
- Evaluation of Amended Aberdeen, Extended Wigglesworth, PSANZ-PDC, ReCoDe, Tulip, and CODAC systems.
- Nine international teams applied systems to 857 stillbirth cases.
- Key metrics included InfoKeep (data retention), Ease (usability), inter-observer agreement (kappa), and unexplained stillbirth proportion.
Main Results:
- CODAC scored highest for data retention (InfoKeep) and usability (Ease).
- Tulip showed the best inter-observer agreement (kappa=0.74) and low unexplained stillbirths.
- Amended Aberdeen and Extended Wigglesworth performed poorly in data retention and agreement.
Conclusions:
- Extended Wigglesworth and Amended Aberdeen are not recommended.
- CODAC, PSANZ-PDC, and ReCoDe show strong performance.
- Tulip excels in agreement and reducing unexplained stillbirths, offering valuable insights for an international classification system.
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