Mortes por sepse: causas básicas dos óbitos após investigação em 60 municípios do Brasil em 2017

Abstract

Introduction: Mortality records are the most widely used data in health assessments. Information on the underlying cause (CB) of death contributes substantially to the development of public policy. Deaths whose CB are classified as Garbage Codes (CG) are considered to be of little use as they do not provide information about the triggering circumstance of death which is fundamental for prevention and avoidability. Aiming at improving the information on mor-tality in Brazil, the Ministry of Health (MS) implemented the investigation of the most common GC in the country through the Data for Health (D4H) initiative. Sepsis corresponds to one of these GC with a high impact on the quality of information on causes of death because it is a secondary exacerbated inflammatory response triggered by infection of an organ or system, and when attested as death CB, the information from the source diagnosis is lost. Objective: To analyze the investigations of sepsis deaths registered in the Mortality Information System (SIM) in 2017, realized by 60 municipalities in Brazil participating in the D4H initiative. Methodology: This dissertation will be presented in the format of an article, which aimed to identify the specific causes detected after the investigation of sepsis deaths in 60 municipalities of the country in 2017 and to evaluate the performance of these municipalities in the record of investigations. Deaths in 2017 in the 60 participating cities of the D4H project whose original CB was registered as sepsis were selected. The data related to the investigations were obtained from the Death Investigation for Ill-Defined Causes – Hospital (IOCMD-H) forms recorded in an online system developed by MS, called Collect2. The proportions of deaths whose CB was changed to a non-garbage cause after investigation were analyzed. Results: Among the 6,486 deaths from sepsis that occurred in the 60 municipalities, 1,584 (24.4%) were investigated and, of these, 1,308 (82.6%) were reclassified with other underlying causes. More than 60% of sepsis deaths reclassified after investigation had chronic non-communicable diseases as the CB (65.6%), with diabetes being the most common specific cause in this group. Communicable diseases (9.6%) and external causes (5.6%) such as falls were also detected as underlying causes. Conclusion: The results evidenced in this study indicate the importance of CG investi-gation routines for improving mortality data.