2023-09-25 Sequence, ICD-11, DORIS Response 4

[mortality-forum]

Hello everyone, I hope you're well.

 Has anyone used or tested the DORIS tool?

 In the following sequence:

a) parkinson's disease

b) gastric ulcer

 The underlying cause of death given by the tool is gastric ulcer.

 Do you accept this sequence?

 Thank you

 Liliana Bernardo

Portugal

 

Response from John O'Connor, Ireland

 Good afternoon,

 I agree with Dr Torres and Kathy from a classification perspective on the sequencing. Whilst it is of tantamount importance that we maintain coding parity in transition to ICD-11 for the production of statistics we must remember the reference guide will serve as a key training tool for coders moving to ICD-11.

 

We need to be able to check linkages etc otherwise we are all merely DORIS interface users?

 

If all relationships accepted by DORIS are not reflected in the reference guide, then it will undermine confidence in the coding tool.

 

Accordingly, these causal relationships need to be accessible in updated decision tables on an ongoing basis or the reference guide needs to encompass the shortfall which as Kathy inferred is considerable.

 

Regards,

John O’Connor Ireland

 

Response from Dr. Yusuf Hemed

 

Dear Liliana Bernardo,

 

Although it is not obvious, but parkinsonism has been linked to gastric disorders eg - gastric damping and the bacteria helicobacter pylori. The exact mechanism is unknown.

 

 

Response from Kathy O’Brien, Canada

 

I agree with Dr. Torres, that for meaningful statistics, Parkinson’s disease should be selected as underlying cause of death, even though there is some research that ulcers and Parkinson’s Disease could be linked, and it was certified as such.  As Dr. Torres pointed out, currently there is no instruction in the Reference Guide to stop the sequence at Parkinson’s, and DORIS is only programed to follow the instructions in the Reference Guide. 

 

This will be a challenge for the mortality community as we implement ICD-11, as the instructions in ICD-10 Volume 2 (which is what the Reference Guide is based on) contained only a portion of the rules that made up the decision tables that were used for ICD-10 underlying cause tabulation.   Therefore, we need to find a way in ensuring that we can continue to produce meaningful statistics in a transparent way as we transition to ICD-11.

 

Kind regards,

 

Kathy O’Brien

Statistics Canada

 

Response from Dr. Torres, Mexico

 

DORIS should have applied SP5 and selected Parkinson's Disease, because this disease is not due to gastric ulcer. Its etiology is unknown, but it is associated with several factors that do not include gastric ulcer. However, this rejected sequence is not found in the ICD-11 Reference Guide and was therefore not applied. This must be included.

 

Dr. Luis Manuel Torres Palacios

Centro Colaborador para la Familia de Clasificaciones Internacionales

de la OMS en México (CEMECE)