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Table 2 Refinement of characteristics and inclusion agreement (% of panel members in agreement) with proposed characteristics in each round of the Delphi

From: Characteristics of a global classification system for perinatal deaths: a Delphi consensus study

Round 1 (N = 71) proposed characteristics Round 2 (N = 52) agreement with system characteristic (%) Round 2 proposed characteristics and notes on changes Round 3 (N = 51) agreement to retain (%) Round 3 preliminary proposed characteristics
1. A global system must have clear guidelines for use 98 A global system must have clear guidelines for use and definitions for all terms used 100 (F1) A global system must have clear guidelines for use and definitions for all terms used
2. A global system must produce data that can be used to inform strategies to prevent perinatal deaths 96.1 A global system must produce data that can be used to inform strategies to prevent perinatal deaths 96 (F2) A global system must produce data that can be used to inform strategies to prevent perinatal deaths
3. A global system must provide clear definitions for all terms used 96.1 Incorporated into #1 - -
4. A global system must produce data that are easily understood and valued by end-users (those that use the cause of death data) 96.1 Incorporated into #8 - -
5. A global system must be available in multiple languages 96.1 Incorporated into #10 - -
6. A global system must be able to work with all levels of data (from both low-income and high-income countries) 94.1 A global system must be able to work with all levels of data (from both low-income and high-income countries), including minimal levels 98 (S1) A global system must be able to work with all levels of data (from both low-income and high-income countries), including minimal levels
7. A global system must allow easy access to the data by the end-users 94.1 A global system must allow easy access to the data by the end-users 92 (F3) A global system must allow easy access to the data by the end-users
8. A global system must be easy to use by those classifying the causes of death 92.6 A global system must be easy to use, and produce data that are easily understood and valued by users 100 (F4) A global system must be easy to use, and produce data that are easily understood and valued by users
9. A global system must have high inter- and intra-rater reliability 92.2 A global system must have high inter- and intra-rater reliability 94 (F5) A global system must have high inter- and intra-rater reliability
10. A global system must be available in different formats including inexpensive ehealth and mhealth options 92.2 A global system must be available in different formats including inexpensive ehealth and mhealth options, and in multiple languages 94 (F6) A global system must be available in different formats including inexpensive ehealth and mhealth options, and in multiple languages
11. A global system must distinguish clearly between causes of death and associated factors 90.6 Incorporated into #19 - -
12. A global system must require neonatal deaths to be clearly distinguished from stillbirths 88.7 A global system must require neonatal deaths to be clearly distinguished from stillbirth 94 (F7) A global system must require neonatal deaths to be clearly distinguished from stillbirths
13. A global system must distinguish between antepartum and intrapartum conditions 88.7 A global system must distinguish between antepartum and intrapartum conditions 90 (S2) A global system must distinguish between antepartum and intrapartum conditions
14. A global system must be useable with minimal data 88.2 Incorporated into #6 - -
15. A global system must include cause of death categories that are relevant in all settings 88.2 Incorporated into #16 - -
16. A global system must use valid causes of death categories 84.9 A global system must ensure cause of death categories are relevant in all settings 96 (S3) A global system must ensure cause of death categories are relevant in all settings
17. A global system must have rules to ensure valid assignment of the cause of death 83 A global system must use rules to ensure valid assignment of causes of death 98 (S4) A global system must use rules to ensure valid assignment of cause of death categories
18. A global system must identify the underlying cause of death 83 A global system must identify the underlying cause of death 78 -
19. A global system must require associated factors to be recorded 81.1 A global system must require associated factors to be recorded and clearly distinguished from causes of death 94 (S5) A global system must require associated factors to be recorded and clearly distinguished from causes of death
20. A global system must allow more than one cause of death to be recorded 80.8 A global system must allow more than one cause of death to be recorded 78 -
21. A global system must require the single most important factor leading to the death to be recorded 78.9 A global system must require the single most important factor leading to the death to be recorded 86 (F8) A global system must require the single most important factor leading to the death to be recorded
22. A global system must have multiple levels of causes of death 77.4 Incorporated into #25 - -
23. A global system must require both primary and secondary causes of death to be recorded 76.9 A global system must require both primary and secondary causes of death to be recorded 73 -
24. A global system must link to relevant birth registries 74.5 A global system must link to relevant birth registries 55 -
25. A global system must have a small number of main categories of causes of death 74.1 A global system must have multiple levels of causes of death, with a small number of main categories 82 (S6) A global system must have multiple levels of causes of death, with a small number of main categories
26. A global system should record the level of data available to assign the cause of death (e.g. verbal autopsy only, placental histology, autopsy, etc.) 73.6 A global system should record the level of data available to assign the cause of death (eg verbal autopsy only, placental histology, autopsy, etc.) 96 (S7) A global system should record the level of data available to assign the cause of death (e.g. verbal autopsy only, placental histology, autopsy, etc.)
27. A global system must incorporate both stillbirths and neonatal deaths 73.6 A global system must incorporate both stillbirths and neonatal deaths 86 (S8) A global system must incorporate both stillbirths and neonatal deaths
28. A global system must include a sufficiently comprehensive list of categories to result in a low proportion of deaths classified as “other” 73.6 A global system must include a sufficiently comprehensive list of categories to result in a low proportion of deaths classified as “other” 80 (S9) A global system must include a sufficiently comprehensive list of categories to result in a low proportion of deaths classified as “other”
29. A global system must require the main mechanism of death to be recorded 71.2 A global system must require the main mechanism of death to be recorded 35 -
30. A global system must reduce the percent of death classified as “unknown” 70.6 A global system must reduce the percent of death classified as “unknown” 59 -
31. The causes of death in a global system must map to the ICD 68.6 The causes of death in a global system must map to the ICD - -
32. A global system’s causes of death must be mutually exclusive (not overlapping) 66.4 A global system’s causes of death must be mutually exclusive (not overlapping) - -
33. A global system must include perinatal deaths for all births after 20 weeks’ gestation 61.5 A global system must include perinatal deaths for all births after 20 weeks’ gestation - -
34. A global system must require preventable factors to be recorded 59.6 A global system must require preventable factors to be recorded - -
35. A global system must require the degree of certainty for each cause of death to be recorded (unlikely, possibly, probably) 56.9 A global system must require the degree of certainty for each cause of death to be recorded (unlikely, possibly, probably) - -
36. A global system must require a principal maternal and a principal fetal/neonatal condition to be classified 55.8 A global system must require a principal maternal and principal fetal/neonatal condition to be classified - -
37. A global system must include all perinatal deaths as a result of induced abortions 55.8 A global system must include all perinatal deaths as a result of induced abortions - -
38. A global system must be hierarchical 53.7 A global system must be hierarchical - -
39. A global system must align with the WHO maternal mortality classification 51.9 A global system must align with the WHO maternal mortality classification - -
40. A global system must be clinical rather than pathological 50 A global system must be clinical rather than pathological - -
41. A global system should be able to generate classifications from other death classification systems 48.2 A global system should be able to generate classifications from other death classification systems - -
42. A global system must not be strictly hierarchical 43.4 A global system must not be strictly hierarchical - -
43. A global system must assign causes of death by computer algorithm 39.2 A global system must assign causes of death by computer algorithm - -
44. There must be separate global systems for stillbirth and neonatal death 35.9 There must be separate global systems for stillbirth and neonatal death - -
45. A global system must use different hierarchy for assigning causes of death for different settings 29.4 A global system must use different hierarchy for assigning causes of death for different settings - -
46. A global system must not include associated factors 17 A global system must not include associated factors - -
  1. Data are sorted in descending order or agreement in Round 1; System characteristics from Round 3 were divided into Structural (S) and Functional (F) characteristics
  2. WHO World Health Organisation, ICD International Classification of Disease