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Moscow Society of Pathologists Department of Health of Moscow Moscow City Center for Pathological Studies Moscow State Medical and Dental University Department of Pathological Anatomy Russian Academy of Medical Sciences of the Research Institute of Human Morphology Russian Medical Academy of Postgraduate Education Pathological Anatomy
O.V.ZAYRATYANTS, L.V.KAKTURSKY, G.G.AVTANDILOV
FORMULATION AND COMPARISON OF FINAL CLINICAL AND PATHOLOGICAL ANATOMIC DIAGNOSIS
The rules for formulating and comparing the final clinical and pathoanatomical diagnoses set out in these guidelines were approved by orders of the Moscow Health Department (1994-2000), decisions of the Academic Councils of the Russian Medical Academy of Postgraduate Education (1995), and the Moscow Health Department (1999-2002). gg.) and Research Institute of Human Morphology RAMS (2001).
Zayratyants Oleg Vadimovich – Doctor of Medical Sciences, Professor, Chief Pathologist of the Moscow Department of Health, Head of the Moscow City Center for Pathological Anatomical Research, Head of the Department of Pathological Anatomy of the Moscow State Medical University, Chairman of the Moscow Society of Pathologists,
Kaktursky Lev Vladimirovich - Doctor of Medical Sciences, Professor, Director of the Research Institute of Human Morphology of the Russian Academy of Medical Sciences.
Avtandilov Georgy Gerasimovich - Doctor of Medical Sciences, Professor, Academician of the Russian Academy of Natural Sciences.
Reviewer: Milovanov Andrey Petrovich, Doctor of Medical Sciences, Professor.
Purpose: for pathologists, forensic experts, clinicians of various specialties, specialists in clinical and expert work, medical statistics.
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Introduction | |
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Basic requirements of the ICD-10 for the formulation of the final clinical and pathoanatomical diagnoses | |
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Rules for the formulation of the final clinical and pathoanatomical diagnoses | |
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underlying disease | |
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Complications of the underlying disease | |
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Accompanying illnesses | |
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Conclusion about cause of death and medical death certificate | |
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Rules for the comparison (comparison) of the final clinical and pathoanatomical diagnoses | |
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Applications | |
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Orders of the Ministry of Health of the Russian Federation | |
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Examples of the formulation of post-mortem diagnoses and medical death certificates | |
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Literature |
Introduction.
The main tasks of the pathoanatomical service during autopsies (pathoanatomical autopsies) are the following:
determination of the initial and immediate causes of death, identification of other pathological processes in persons who died a non-violent death (formulation of a pathoanatomical diagnosis, conclusion on the cause of death, clinical and anatomical epicrisis, filling out a medical certificate of death, coding according to ICD-10 of the original cause of death);
comparison (comparison) of the results of autopsy - a pathoanatomical diagnosis - with the final clinical diagnosis and other data from intravital studies (analysis deaths- clinical and expert work, i.е. conducted collegially, together with experts from other clinical specialties and administrative health workers, analysis of the quality of medical and diagnostic work of medical institutions);
development of autopsy materials in the scientific-practical and scientific-methodological terms (development of general and particular pathology, statistical analysis of mortality, etc., including participation in the planning and implementation of healthcare development programs).
In this regard, the requirements for the reliability of information provided by the pathoanatomical service and the responsibility assigned to pathologists are extremely high.
The reliability of the data provided by the pathoanatomical service on the causes of death of the population and on the quality of medical and diagnostic work of medical institutions depends on the unification and strict adherence to the rules for formulating and coding clinical and pathoanatomical diagnoses, the principles of comparison (comparison) of the final clinical and pathoanatomical diagnoses, the exact fulfillment of the requirements for issuance of a medical certificate of death. These rules and principles of medical informatics are based on the requirements of the International Statistical Classification of Diseases and Related Health Problems of the Tenth Revision (ICD-10) and administrative documents of the Ministry of Health of the Russian Federation, as well as, for Moscow medical institutions, orders of the Moscow Health Department.
In spite of great attention Given to these issues by the health authorities and, in particular, the pathoanatomical service, various errors are often revealed in the preparation and comparison of diagnoses, both among pathologists and, especially, among clinicians. The most common such errors are unclassified diagnoses and comparison of clinical and pathoanatomical diagnoses only for the first nosological unit as part of the combined underlying diseases. Many new questions and difficulties arose during the transition to the use of the ICD-10 in the work.
Purpose of the guidelines- briefly present the rules for formulating (building) and comparing (comparing) the final clinical and pathoanatomical diagnoses, issuing a medical death certificate, encoding (coding) the causes of death, the main provisions for analyzing lethal outcomes based on the requirements of ICD-10.
Guidelines are intended for pathologists, forensic medical experts, clinicians of various specialties, specialists in clinical expert work and medical statistics, for use in the work of clinical expert commissions of medical institutions, when passing advanced training courses and certification of pathologists.
Publication Requirements
(for publication Proceedings of the Society of Pathologists
St. Petersburg and Leningrad region) .
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RUSSIAN SOCIETY OF PATHOLOGISTS
RUSSIAN RESPIRATORY SOCIETY
FSBI "RESEARCH INSTITUTE OF HUMAN MORPHOLOGY"
FSBI "RESEARCH INSTITUTE OF PULMONOLOGY" OF THE FEDERAL MEDICAL AND BIOLOGICAL AGENCY OF RUSSIA
SBEE HPE "RUSSIAN MEDICAL ACADEMY OF POSTGRADUATE EDUCATION" MINISTRY OF HEALTH OF RUSSIA
GBOU HPE "RUSSIAN SCIENTIFIC RESEARCH MEDICAL UNIVERSITY named after A.I. N.I. PIROGOV»
PRINCIPLES OF CONSTRUCTION OF A PATHOTOANATOMICAL DIAGNOSIS IN DISEASES OF THE RESPIRATORY ORGANIS AND ITS CODING ACCORDING TO ICD-10
PROFILE COMMISSION ON SPECIALTY
"PATHOLOGICAL ANATOMY"
Compiled by: academician of the Russian Academy of Sciences, professor G.A.Frank, Head of the Department of Pathological Anatomy, SBEI HPE RMAPE of the Ministry of Health of Russia, chief freelance pathologist of the Ministry of Health of Russia; academician of the Russian Academy of Sciences, professor A.G. Chuchalin, director of the Research Institute of Pulmonology of the Federal Medical and Biological Agency of Russia, chief freelance therapist of the Ministry of Health of Russia, professor A.L. Chernyaev, Professor L.V. Kaktursky, Head of the Central Clinical Laboratory of the Federal State Budgetary Scientific Institution Research Institute of Human Morphology, Chief Freelance Pathologist of Roszdravnadzor, President Russian Society pathologists; Professor O.D.Mishnev, Head of the Department of Pathological Anatomy and Clinical Pathological Anatomy, State Budgetary Educational Institution of Higher Professional Education, Russian National Research Medical University named after A.I. N.I. Pirogov; M.G. Rybakova, Head of the Department of Pathological Anatomy, St. Petersburg State Medical University. N.I. Pavlova of the Ministry of Health of Russia, chief freelance pathologist of the Committee on Healthcare of St. Petersburg; O.O. Orekhov, Candidate of Medical Sciences, Head of the Pathological Anatomical Department of City Clinical Hospital No. 67, Chief Freelance Pathologist of the Moscow Department of Health; MD M.V. Samsonova, Head of the Laboratory of Pathological Anatomy and Immunology, FGBU "Research Institute of Pulmonology" of the Federal Medical and Biological Agency of Russia, L.M. Mikhaleva Professor Head of the Laboratory of Clinical Morphology FGBNU Research Institute of Human Morphology, Professor O.S.Vasilyeva, Head of the Laboratory of Occupational Lung Diseases, Research Institute of Pulmonology, FMBA of Russia.
METHODOLOGY.
Methods used to collect/select evidence.
Search in electronic databases.
Description of the methods used to collect/select evidence.
The evidence base for these recommendations are publications included in the Cochrane Library, EMBASE and MEDLINE databases, ICD-10, MNB.
Methods used to evaluate the quality and strength of the evidence
Expert Consensus
Development of ICD-10
The study of the MNB.
Methods used to formulate recommendations
Expert Consensus
Consultations and expert evaluation.
The preliminary version was discussed at a meeting of the profile commission on the specialty "pathological anatomy" of the Ministry of Health of Russia on February 19, 2015, at a meeting of the Moscow Society of Pathologists on April 21, 2015, and posted on the website of the Russian Society of Pathologists for a wide discussion, so that persons who did not participate in profile committee, had the opportunity to review and discuss the recommendations. The final approval of the recommendations was carried out * by the Plenum of the Russian Society of Pathologists on May 22-23, 2015 in Petrozavodsk.
The draft recommendations were reviewed by independent experts who commented primarily on the clarity and accuracy of interpretations of the evidence base underlying these recommendations.
Working group.
For the final revision and quality control, the recommendations were re-analyzed by the members of the working group, who came to the conclusion that all the comments and comments of the experts were taken into account, the risk of systematic errors in the development of recommendations was minimized.
Method formula.
The technique of using the ICD-10 in the practice of domestic pathological anatomy is given. The rules for filling in statistical accounting documents are outlined: a pathoanatomical diagnosis, a medical certificate of death. The adaptation of ICD-10 codes with the peculiarities of domestic diagnostic terminology was carried out.
Indications for use.
The unified use of the ICD-10 throughout the country is necessary to ensure interregional and international comparability of statistics on mortality and causes of death in the population.
Logistics.
International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10).
"Medical certificate of death" - approved by order of the Ministry of Health of the Russian Federation No. 241 of 08/07/1998
The recommendations are intended for pathologists, forensic experts, pulmonologists and doctors of other specialties, as well as for teachers of clinical departments, graduate students, residents, interns and senior students of medical universities.
The objectives of this work are the development of modern standard principles for constructing (formulating) the final clinical and pathoanatomical diagnoses in respiratory diseases in order to obtain unified indicators for statistical studies in accordance with the requirements of the WHO ICD. Examples of constructing a pathoanatomical diagnosis in lung pathology are given.
The recommendations are based on a summary of literature data and the authors' own experience. We are aware that the construction and formulation of diagnoses may change in the future as new scientific knowledge accumulates. Therefore, despite the need to unify the formulation of the pathoanatomical diagnosis in diseases of the respiratory system, some of our proposals may serve as a reason for discussion. In this regard, any other opinions, comments and wishes of readers will be accepted by the authors with gratitude.
INTRODUCTION
According to the reports of the Ministry of Health of the Russian Federation for 2013, respiratory diseases [RD] (class X according to ICD-10) in terms of incidence amounted to absolute numbers 24024922 or 20634.2 per 100 thousand people and firmly hold the 5th place among all diseases. Of these, diseases such as pneumonia, chronic obstructive pulmonary disease (COPD), bronchial asthma, interstitial lung diseases account for 15.5% of all BOD. AT Russian Federation in 2013, the mortality from AML was 51.6 per 100 population (74068 deaths), of which 26.7 per 100 thousand of the population with pneumonia, 21.2 per 100 thousand of the population with COPD, with bronchial asthma (BA) - 1.2 per 100 thousand population. Mortality from chronic lung diseases among all those who died from AML is 38.9%, during post-mortem autopsy - 34.5%. The share of discrepancies between clinical and pathoanatomical diagnoses for pneumonia in 2013 was 11.3%, for chronic lung diseases this figure was 32.1%.
The basis for the construction of a pathoanatomical diagnosis is based on three principles: 1) a nosological approach to the construction of a pathoanatomical diagnosis; 2) building a pathoanatomical diagnosis in accordance with the International Nomenclature of Diseases (MNB), in particular the "List of diseases of the lower respiratory tract» (1979), guidelines and national programs All-Russian Society pulmonologists; 3) coding of the clinical diagnosis according to the International Statistical Classification of Diseases and Related Health Problems X revision, Geneva 1995 (ICD-10) and WHO recommendations (ICD-10, volume 2), as well as added headings in accordance with the WHO update 1996-2012 gg. (Letter of the Ministry of Health of Russia dated December 05, 2014 No. 13-2 / 1664).
The nosological principle of making a diagnosis is a tradition of the Russian clinical school.
The nosological form is a disease isolated on the basis of etiology, pathogenesis and a characteristic clinical and morphological picture; it is a unit of nomenclature and classification of diseases.
When studying the disease, a complex of pathological changes in various systems organism. In addition, these systems are constantly influenced by many external factors. The reflection of this complex process is the diagnosis - the process of knowing the essence of pathological changes, conditions, diseases.
The diagnostic and treatment process is a single whole. In this regard, clinical and pathoanatomical diagnoses cannot be only a list of nosological units, syndromes and symptoms identified in a patient, but should most fully reflect all pathological changes and comply with the following principles:
Nosological (taking into account the requirements of ICD-10 and the possibility of statistical accounting);
Intranosological (clarification of the form, stage of activity, severity, degree of dysfunction);
Pathogenetic (reflecting the sequence of development of pathological processes and diseases, the degree of their relationship, the features of their integral manifestations and consequences);
Dynamic (change in pathological conditions during the course of the disease and its treatment);
Structural (formulation of a diagnosis taking into account thanatogenesis, reflection of the sequence, subordination of processes, features of their interaction).
ICD-10 is the latest in a series of classification revisions, the first of which was formalized in 1893 as the Bertillon classification, or International List causes of death. In the modern ICD-10, pathological conditions are grouped in such a way as to ensure its maximum acceptability when used for solving general epidemiological problems, as well as for assessing the quality of health care delivery. .
The main purpose of the international nomenclature of diseases (ISD) is to define the name of each nosological entity. The main criteria for choosing a name are its specificity, lack of ambiguity, simplicity, expression of the essence of the disease and an indication of the cause that causes it. In the MNS, the definitions of all diseases and syndromes are concise, each definition is supplemented by a list of synonyms. In 1979, a list of diseases of the lower respiratory tract (Diseases of the low respiratory tract) was published, which should be used in formulating a clinical diagnosis.
The final clinical and final pathological diagnoses should contain the following headings:
underlying disease,
background disease,
Complications,
Accompanying illnesses.
The diagnosis is completed by determining the immediate cause of death.
The consequences of resuscitation, as well as the type of surgical intervention, are recorded in a separate line of the diagnosis (most often under the headings of the underlying disease or complications).
In the presence of several diseases (comorbidity), the main disease is distinguished, giving preference to:
The nosological entity most likely to be the underlying cause of death;
More severe in nature, complications and consequences of the nosological form;
A disease whose thanatogenesis was leading.
In cases where the above does not allow to identify the priority of one of the nosological units, the first one in the pathoanatomical diagnosis is indicated more significant in the social and sanitary-epidemiological aspect; requiring large economic costs in the course of medical and diagnostic measures; put first in the final clinical diagnosis (if a pathoanatomical diagnosis is formulated).
Table 1
STRUCTURE OF DIAGNOSIS (Avtandilov G.G., 1994)
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A. Monocausal |
B. Bicausal |
B. Multicausal |
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underlying disease Complications
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Combined underlying disease: - two competing diseases; - two associated diseases; - combined diseases Complications Accompanying illnesses |
1.Polypathy a) etiologically and pathogenetically related several diseases and conditions (family of diseases); b) random combinations association of several diseases and conditions (disease association) Complications
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In Russia, as well as throughout the world, for international comparisons, in most reporting forms of causes of death, only one nosological form or the first in the combined underlying disease is coded and taken into account in statistical developments.
PNEUMONIA
In the structure of the final clinical and pathoanatomical diagnoses, "Pneumonia" can occupy various positions.
First, pneumonia is seen as underlying disease(initial cause of death), independent or comorbid, has its own ICD code and strong clinical and pathological grounds for such a conclusion.
Secondly, "Pneumonia" is often and reasonably included in the diagnosis as complication of the underlying disease, and, accordingly, the world does not currently receive an ICD code for subsequent statistical analysis.
Finally, fourthly, pneumonia can be observed in conditions classified in other headings and having corresponding ICD codes. For example, these include: congenital pneumonia ( P23.9 ), pneumonia of newborns ( P24.9 ), pneumonia during anesthesia during pregnancy ( O29.0 ), childbirth ( O74.0 ), postpartum period ( O89.0 ), pneumonia (in ICD: pneumonitis) by inhalation of solid and liquid substances ( J69.- ) and others,
In the rubrics of pneumonia, the etiological (microbiological) coding principle prevails, therefore, when the etiology of pneumonia is clarified, when it is considered as the underlying disease, the corresponding ICD-10 code should be used. To determine the pathogen, it is necessary, first of all, to use the results of intravital microbiological and other modern laboratory research methods. It is recommended to conduct microbiological and bacterioscopic examination of cadaveric material. In cases where the causative agent of pneumonia cannot be identified, as an exception, use codes J18.0 – Bronchopneumonia, unspecified and J18.1 – Lobar pneumonia, unspecified.
Diagnosis of "Hypostatic pneumonia" ( J18.2 ) cannot be considered as the underlying disease and is not coded. From the conclusion about the presence of hypostatic pneumonia, one should refrain from conducting a microscopic examination, since often against the background of plethora in the lungs, the morphological substrate of pneumonia may be absent.
When formulating the diagnosis of pneumonia in clinical and pathoanatomical practice underlying disease with appropriate justification may be:
viral pneumonia (see rubrics J09 – J12 ),
bacterial pneumonia (see rubrics J13 – J 16 ),
viral-bacterial pneumonia (there are no corresponding headings in the ICD-10, they are coded according to the corresponding viral pneumonia, with the inclusion of bacterial manifestations in the diagnosis),
pneumonia caused by atypical pathogens (mycoplasma, chlamydia, legionella, coxiella Burnett). At the same time, pneumonia caused by legionella is taken into account in another heading ( A48.1 Legionnaires' disease).
At viral pneumonia, in particular, with influenza, the pathoanatomical diagnosis should be formulated, taking into account the heading added by WHO to the ICD J09 Influenza caused by a certain identified influenza virus, as well as saved rubrics J10 Influenza caused by an identified influenza virus and J11 Influenza, virus not identified.
Other viral pneumonias are presented under the heading J12 Viral pneumonia, not elsewhere classified. Pneumonia caused by respiratory syncytial virus found its place here ( J12.1 ), adenoviruses ( J12.0 ), parainfluenza viruses ( J12.2 ), as well as other viral pneumonias ( J12.8 ), including unspecified ones ( J12.9 ). In accordance with the WHO updates, the ICD has been supplemented: J12.3 Pneumonia due to human metapneumovirus. An additional section has also been added. J21.1 Acute bronchiolitis due to human metapneumovirus.
An example of a variant of the pathoanatomical diagnosis for influenza:
underlying disease. J10. Influenza A (H1 N1) (indicate the variant of influenza according to the virological study, on the basis of which research methods it was established - PCR of nasopharyngeal swabs or prints from the nasopharyngeal mucosa, cultivation of the virus on chicken embryos, indicate the antibody titer and the date of the study): bilateral acute lung damage according to the type of acute respiratory distress syndrome in adults, confirmed by clinical and radiological data, acute hemorrhagic laryngotracheitis.
Background diseases(if there is). Obesity (degree, body mass index (BMI) data), pregnancy (gestational age, its complications), COPD (confirmed by functional indicators external respiration), bronchiectasis, bronchial asthma (form, severity, controlled / uncontrolled), diabetes(type, compensation/decompensation), arterial hypertension and/or ischemic heart disease, chronic alcohol intoxication, chronic alcoholism.
Complications. Morphological substrate and clinical data of ARF (degree), circulatory failure. Cor pulmonale (in COPD). Cerebral edema (if any).
Resuscitation and intensive care. Tracheal intubation (tracheostomy - duration) and mechanical ventilation (if performed, how many days). Complications of tracheal intubation and mechanical ventilation.
Accompanying illnesses. Atherosclerosis (localization, severity). Chronic gastric ulcer in remission.
b) diffuse alveolar damage
c) influenza A (H1 N1).
II. Obesity 3 degrees
Aspiration pneumonia in adults, it is almost always a complication of the underlying disease. With aspiration pneumonia, the anaerobic flora of the oral cavity is determined (Bacteroides, Prevotella, Fusobacterium, Peptostreptococcus), as well as a mix of aerobes (Streptococcus pneumonia, Staphylococcus aureus, Haemophilus influenza, Pseudomonas aeruginosa)
In the presence of abscesses with a diameter of less than 2 cm, it is legitimate to use the term focal confluent bronchopneumonia with abscess formation as a complication of the underlying disease. Lung abscess acquires the status of the main disease only in those cases when the diameter of the abscess exceeds 2 cm.
In malignant neoplasms, pneumonia (paracancrotic) is a complication of the underlying disease. This also applies to pneumonia in immunocompromised states.
The term " Chronic pneumonia" should not appear in the pathoanatomical diagnosis, since there is no single etiological and morphological basis for this syndrome. Currently, the names of specific nosological forms and their etiological factors (Nocardia, Actinomyces, Mycobacterium tuberculosis, Mycobacterium avium-intracellulare, Histoplasma capsulatum, other pathogens that cause granulomatous inflammation and cavern formation) should be used.
ICD
X
division and coding of pneumonia into community-acquired (domestic, contagious, including atypical) and nosocomial (hospital, nosocomial, including those caused by atypical pathogens) is not provided.
According to the recommendations of the Russian Respiratory Society (2010), community-acquired pneumonia is an acute disease that occurred in a community setting (outside the hospital) or diagnosed within the first 48 hours from the moment of hospitalization, or developed in a patient who was not in nursing homes / long-term care units more than 14 days, - accompanied by symptoms of infection of the lower respiratory tract (fever, cough, sputum production, chest pain, shortness of breath) and radiological signs of "fresh" focal-infiltrative changes in the lungs in the absence of an obvious diagnostic alternative ( Practical recommendations on diagnosis, treatment and prevention of community-acquired pneumonia in adults, Russian Respiratory Society, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, 2010).
The most severe community-acquired pneumonia occurs in the elderly, against the background of concomitant diseases (oncological and hematological diseases, diabetes mellitus, cardiovascular diseases, kidney and liver disease, chronic obstructive pulmonary disease, alcoholism, viral infections and others). Mortality in this case is 15 - 30%. Such community-acquired pneumonias are considered either as part of a combined underlying disease.
According to researchers, in Russia the incidence of community-acquired pneumonia among all age groups is 10-15 cases per 1000 population. Mortality from this nosology in the mid-90s was about 2.2% of cases of hospitalized patients, and by the beginning of 2000 it had reached 5% among middle-aged people and 30% among the elderly. According to the weekly monitoring carried out by Rospotrebnadzor, in the period 2009-2012. mortality from community-acquired pneumonia (registered according to operational data) averaged 0.5% weekly, reaching up to 1.2% during the pandemic spread of influenza A H1N109, and 0.9% in 2011.
According to the order of the Ministry of Health of Russia No. 300 of 10/18/1998 "Standards for the diagnosis and treatment of pneumonia and obstructive pulmonary disease", errors in the diagnosis of community-acquired pneumonia reach 20%, the diagnosis is made in the first 3 days of the disease only in 35% of patients.
Community-acquired pneumonia should be separated from nosocomial (nosocomial, hospital-acquired) pneumonia as a separate form that has fundamentally different epidemiological features, including both the spectrum of pathogens and factors of the epidemic process, and, accordingly, other principles of treatment and preventive measures.
Nosocomial (nosocomial) pneumonia, as a rule, are secondary pneumonias, i.e. complication of the underlying disease. The main causative agents of nosocomial pneumonia at present are: Klebsiella pneumoniae, Serratia marcescens, Esherichia coli, Pseudomonas spp., as well as penicillin-resistant strains of Staphylococcus aureus. In a number of exceptional cases, the status of nosocomial pneumonia in the clinic can be raised to the level of the underlying disease.
If it is impossible to conduct a bacteriological study, it is imperative to determine the tinctorial properties of the pathogen when stained by Gram (positive or negative) and include this in the pathoanatomical diagnosis for the etiological characteristics of the disease. In these cases, you should use the code J15.8 Other bacterial pneumonias indicating in the diagnosis of gram-negative or gram-positive microflora. In addition, the ICD provides a code J15.9 Bacterial pneumonia, unspecified, which, apparently, should not be used, since it is an indicator of an inferior pathoanatomical study.
When characterizing pneumonia, one should indicate its localization (segment, share) and variant (focal, focal-confluent, pleuropneumonia).
Examples of the formulation of a pathoanatomical diagnosis and their coding according to ICD-10
Pneumonia is the main disease
underlying disease. J13. Pneumonia: pneumococcal confluent of the lower lobe of the right lung, or caused by St. pneumonia, with limited (common) fibrinous pleurisy.
Complications. Fibrinous pericarditis. Pulmonary edema.
Medical death certificate
I. a) acute respiratory failure.
b) right-sided lower lobe pneumococcal pleuropneumonia
G) -.
underlying disease. J15.2. Pneumonia: staphylococcal, focal confluent in the 6th–10th segments of the right lung.
Complication. Non-cardiogenic pulmonary edema.
underlying disease J15.8. Pneumonia: caused by gram-positive bacterial flora, bilateral focal lower lobe.
underlying disease J15.8. Pneumonia: caused by gram-negative bacterial flora, focal-confluent in the lower lobe (or segments 6-10) of the left lung.
underlying disease J18.1. Pneumonia: right-sided lower lobe.
Medical death certificate
I. a) Acute respiratory failure.
b) right-sided lower lobe pleuropneumonia
G) -.
.
Pneumonia is a complication of the underlying disease
The main combined disease.
I 61.0. Intracerebral hematoma (size) in the region of the parietal and occipital lobes of the right hemisphere of the brain. Stenosing atherosclerosis of the arteries of the base of the brain (localization, degree, stage).
background disease. Arterial hypertension (characteristic of changes in the heart and kidneys).
Complications. Focal (focal-confluent) bronchopneumonia caused by Kl. pneumoniae, in the 5th–10th segments of the right lung. Pulmonary edema. Cerebral edema.
In malignant neoplasms, pneumonia (paracancrotic) is a complication of the underlying disease.
Medical death certificate
I. a) acute respiratory failure.
b) right-sided lower lobe bronchopneumonia
c) intracerebral hematoma.
II. Arterial hypertension .
underlying disease. J.85.1. Abscess in 1-3 segments of the right lung with organizing perifocal pneumonia, drained by 2 segmental bronchus.
Complications. Right-sided fibrinous-purulent pleurisy or pleural empyema (200 ml).
Medical death certificate
I. a) purulent intoxication
b) abscess in the upper lobe of the right lung with pneumonia [ J85.1]
G) -.
underlying disease. By 25.0. Chronic ulcer of the lesser curvature of the stomach with bleeding. Laparotomy, ulcer closure, drainage abdominal cavity(the date).
Complications. Reflux esophagitis (according to the medical history).
Aspiration pneumonia in 1-3 segments of the right and 6-10 segments of the left lung.
underlying disease. F 10.1. Chronic alcohol intoxication with multiple organ manifestations.
Complications. Aspiration focal-confluent bronchopneumonia in 6-10 lung segments or bilateral aspiration lower lobe pneumonia.
Chronic obstructive pulmonary disease (COPD).
Code J.41 is recommended for use in cases of non-obstructive bronchitis and/or reversible obstruction. In other words, this code can only be used if the large bronchi are affected. Chronical bronchitis may be an underlying or concomitant disease.
COPD in the pathoanatomical diagnosis can take positions main(including comorbid), background or accompanying diseases.
The most commonly used codes are J.44 denoting chronic obstructive pulmonary disease (COPD), which consists of three constituent parts: chronic diffuse bronchitis and bronchiolitis, pneumosclerosis of the interlobular connective tissue (peritbronchial and perivascular pneumosclerosis can only be detected histologically), pulmonary emphysema (most often a combination of centrolobular and bullous). At the same time, increasing progressive airway obstruction is clinically determined, leading to the development of respiratory, pulmonary heart failure, secondary pulmonary hypertension and cor pulmonale. The pathoanatomical diagnosis of COPD can be made at autopsy only on the basis of the three signs (diseases) listed above. For exacerbations of COPD, two codes should be used: J.44.0 (with respiratory infection of the lower respiratory tract, including viral) and J.44.1 (with bacterial or unspecified exacerbation).
Code J.44.8 (other specified COPD) - should be used for chronic obstructive bronchitis without emphysema without exacerbation and various forms obliterating bronchiolitis without exacerbation.
Secondary arterial pulmonary hypertension with the formation of cor pulmonale is a complication of COPD, since they may not develop in all cases.
The Russian Society of Pathologists expresses its solidarity with the entire medical community regarding the rejection of the decision of the Cheremushkinsky District Court of Moscow in the case of the hematologist Elena Misyurina and is convinced that a gross expert and monstrous judicial error has occurred, which can have extremely negative consequences for the national health care as a whole and for the pathoanatomical service, in particular.
Elena Misyurina Sergey Savostyanov/TASS
The Russian Society of Pathologists agrees with the opinion of authoritative Russian doctors on the need to re-examine the case and recommends involving its most experienced specialists to participate in any expert commissions on the case of doctor E. Misyurina, including the complex commission proposed by the National Medical Chamber to achieve objective and fair decision.
At the same time, we note that the main reasons for the expert error were the surgeons' intraoperative diagnosis of vascular injury allegedly caused by trepanobiopsy, as well as defects in the documentation of the postmortem autopsy of the deceased patient. At the heart of defects in pathoanatomical documentation are accumulated unresolved organizational problems and erroneous management decisions. recent years concerning the work of the pathoanatomical service in the country, to which Deputy Prime Minister Olga Golodets rightly drew attention, and which the leadership of the Russian Society of Pathologists has been talking about tirelessly and at all levels in recent years.
The pathoanatomical service in the country is practically on the verge of destruction. The concept of a pathoanatomical service terminologically has already lost its right to exist in regulatory documents. Intravital (biopsy) diagnostics are increasingly being attributed to clinical and laboratory diagnostics, and autopsies - to forensic medical examination, which extremely negatively affects the quality of conclusions both in vivo, on which the life and health of patients depend, and post-mortem, affecting the fate of our patients. colleagues - clinicians, which was clearly manifested in the case of E. Misyurina.
Federal Law No. 323-FZ “On the Fundamentals of Protecting the Health of Citizens in the Russian Federation” contains practically no articles regulating intravital pathoanatomical examinations (which is the most important part of the work of a pathologist), and article 67 “Carrying out pathoanatomical autopsies” contains shortcomings that require significant corrections
There are a lot of complaints about the regulatory documents of recent years from professional community regarding their law enforcement practice, they negatively affect the work of the pathoanatomical service, do not solve the accumulated problems and require significant adjustment. The work of a pathologist in the conditions of the current regulatory documents is inefficient, leading to a rapid professional burnout and professional decline.
Unfortunately, the appeals of the Russian Society of Pathologists were not heard, and the case of doctor E. Misyurina, to a certain extent, is the result of accumulated problems in the pathoanatomical service.
President of the Russian Society of Pathologists L.V. Kaktursky
Vice President of the Russian Society of Pathologists O.V. Zayratyants
Vice President of the Russian Society of Pathologists F.G. Zabozlaev
Vice President of the Russian Society of Pathologists L.M. Mikhaleva
Member of the Presidium of the Russian Society of Pathologists, Chief Pathologist of the Moscow Department of Health O.O. Orekhov
