Reasons for medical care outpatient who died from “unspecified” diseases of the nervous system

The number of patients with multiple diseases is increasing globally, leading to challenges in determining the primary cause of death (PCD). Often, the medical death certificate (MDC) lists nosologically unjustified codes as the PCD. The aim of this study is to investigate the reasons for outpatient medical visits by patients whose PCD after death was recorded as unspecified encephalopathy (G93.4), cerebral cyst (G93.0), and senile degeneration of the brain (G31.1); and to discuss possible reasons for these codes being listed as the PCD. Material and methods . Data from the electronic database of the Main Directorate of the Civil Registry Office of the Moscow Region (USR system of the Civil Registry Office of the Moscow Region) and electronic medical records (EMR) from outpatient clinics (APU) for 2020–2021. In total, 15,741 cases were registered in the MCC with codes G93.4, G93.0 and G31.1 indicated as UCD, of which 11,678 (74.2%) applied to the APU. Results . There were no recorded instances where the sole reason for outpatient visits was codes G93.4, G93.0, and G31.1. Nearly 80% of patients who had one of these three codes listed as PCD after death had visited outpatient clinics more than once. The average number of outpatient visits for any reason was 6.8 ± 8.8. Almost 70% had registered cardiovascular diseases (CVD) (of which 42.9% were cerebrovascular diseases), cancer accounted for 7.2%; diabetes mellitus for 5.3%; and nervous system diseases (NSD) for 8.8%; while 11% were related to COVID-19. The overwhelming majority of deaths coded as PCD G31.1 and G93.4 occurred in individuals aged 75 to 95 years (84% and 77.5%, respectively), while for code G93.0 it was 63.2%. In each subgroup of deceased individuals, women predominated, with an average age (84.6 ± 8.1 years) higher than that of men (78.5 ± 10.8 years). Conclusions . Codes G93.4, G93.0, and G31.1 as PCD are predominantly used in older age groups against a backdrop of repeated outpatient visits and multimorbidity. It is insufficient to simply prohibit their use; a coordinated position among specialists is necessary to select the appropriate PCD (and corresponding code) in cases of non-life-threatening multimorbid pathology in elderly individuals