Introduction

In 2008, USTUR is completed the process of consistently coding all death

certificates and autopsy reports under Revisions 9 and 10 of the International
Classification of Diseases (ICD-9-CM and ICD-10, respectively).
Professional
nosologist, Carolyn Watkins, reviewed all autopsy reports and death certificates in
order to code the underlying cause of death and up to seven contributing causes of
death for deceased USTUR registrants.
These data are stored in the USTUR pathology database which has been deidentified and made available internationally via the World Wide Web.

Online Database
MS Access format
To Download:
1. Go
to
USTURs
Pathology
Data
Download
page:
http://www.ustur.wsu.edu/DeidentifiedData/Pathology.html.
2. Determine which version of Microsoft Access your computer system is
running and click on either the Pathology_Office2007.accdb or the
Pathology_Office2003.mdb link.
3. Open the zip file and save a local copy of the pathology database.
4. Open the local copy of the database and enable macros. Note: searches and
buttons will not function properly if macros are disabled.
5. Browse pathology results using the record navigation buttons in the upper left
corner of the form or click on the Search Pathology button to search for
specific ailments or case numbers.

Definitions
Case No: A unique, four-digit number assigned by the USTUR for each registrant.
Examiners Notes: Cause of death records that reproduce the wording used on the
autopsy reports, certificates, and/or other documents in the hard file. These records
do not correlate in a one-to-one relationship with ICD codes and they are intended
to supplement, but no supersede, ICD-9-CM and ICD-10 codes.
ICD-9-CM code: A numeric code that is used to classify a disease according to the
International Statistical Classification of Diseases and Related Health Problems,
Revision 9, clinical modification (ICD-9-CM).
ICD-9-CM description: The name and/or description of a disease classified under
ICD-9-CM. Each description refers to a unique ICD code.

ICD-10 code: An alphanumeric code that is used to classify a disease according to

the International Statistical Classification of Diseases and Related Health Problems,
Revision 10 (ICD-10).
ICD-10 description: The name and/or description of a disease classified under
ICD-10. Each description refers to a unique ICD code.
ICD Keywords: Terms used to search ICD descriptions and Examiners notes.
Relation to Death: A one-digit code that indicates of how a medical condition
contributed to a registrants death. 0 = underlying cause of death, 1-7 = other
causes of death where 1 is most severe and 7 is least severe.
Source Code: The source of information used to assign an ICD code, displayed as a
one-digit code: A = autopsy report, or D = death certificate.

Main Pathology Form

When the USTUR database is opened, the Main Pathology form is the first screen
that is displayed. It provides all ICD and Examiners Notes data for a single case.
Cases can be browsed using the Record Navigation buttons in the upper right corner
of the form or a specific case number can be selected using the Find Case button.
More complex searches for specific causes of death are conducted and reports
generated using the Search Pathology and Generate Report buttons, respectively,
which are located in the lower right corner of the form.
The Main Pathology form breaks USTUR cause of death data into three sections:

ICD-9-CM Cause of Death: Displays ICD-9-CM codes and descriptions for the
underlying cause of death and up to seven contributing causes of death. It also
shows the relation to death and source code for each ICD-9-CM record.
ICD-10 Cause of Death: Displays ICD-10 codes and descriptions for the underlying
cause of death and up to seven contributing causes of death. It also shows the
relation to death and source code for each ICD-10 record.
Examiners Notes: Displays all Examiners Notes. These records are not listed in
any particular order.
Buttons on the Main Pathology form facilitate case navigation, link to the Search
Pathology form, and generate pathology reports:
Find Case: Click this button and enter a four-digit case number into the Find What
field to look up a specific case number. Note: Leading zeros must be added to case
numbers that are less than four digits long (e.g. case #28 must be entered as
0028).
Record Navigation: The Record Navigation buttons First, Previous, Next, and
Last are used to browse pathology data by jumping back to the first case, backing
up to the previous sequential case number, moving to the next sequential case
number, or jumping to the last case, respectively.
Search Pathology: Opens the Search Pathology form, where pathology records
can be searched by case number, ICD-9-CM information, ICD-10 information, and
Examiners Notes.
Generate Report: Generates a report for the current case number. The report will
be opened in print preview mode.

Search Pathology Form

Search International Classifications of Diseases (ICD) Records

The Search Pathology form allows the user to search for ICD codes by case
number, ICD-9-CM code, ICD-10 code, or keywords. Keyword searches identify
matching search terms in both the ICD-9-CM condition descriptions and the ICD-10
descriptions. Thus if a user searches on liver and neoplasm, a record that has liver
(but not neoplasm) in the ICD-9-CM description and neoplasm (but not liver) in the
ICD-10 description would be a positive match.
Search Examiners Notes by Keyword
The pathology database also contains cause of death records that reproduce the
wording used on the autopsy reports, certificates, and/or other documents in the
hard file. These Examiners Notes overlap with the ICD codes but do not correlate
to them in a one-to-one relationship. Thus they are searched separately from the
ICD codes. Keyword searches of the Examiners Notes can be conducted from the
Search Pathology form.

ICD Search Results

The ICD Search Results form displays the following data in a tabular format:
Case Number
Relation to Death
ICD-9-CM code
ICD-9-CM description
Source of ICD-9-CM information
ICD-10 code
ICD-10 description
Source of ICD-10 information
Button that links the user to the Examiners Notes for the selected case
number.
These data are sorted by case number and can be printed using the print button at
the top of the form. This will open a report in print preview mode.
Note: Only one report can be viewed in print preview at a time. If the print button is
not displaying the correct data, try closing old reports and clicking print a second
time.

Examiners Notes Results

The Examiners Notes Search Results form displays the following data in a tabular
format:
Case Number,
Examiners Note,
Button that links the user to ICD data for the selected case number.
These data are sorted by case number and can be printed using the print button in
the upper right corner of the form. This will open a report in print preview mode.
Note: Only one report can be viewed in print preview at a time. If the print button is
not displaying the correct data, try closing old reports and clicking print a second
time.

Report Generator
De-identified reports for individual cases can be generated from the main pathology
page. When the Generate Report button is clicked a report for the current case will
be opened in Preview mode. The user can review the report and print it using the
print
button
in
the
Microsoft
Access toolbar. Each report contains all ICD-9-CM codes, ICD-10 codes, and
Examiners Notes associated with a single case number. And example report for
case 0002 is provided below.

Example Pathology Report for Case 0002

Pathology Report
United States Transuranium and Uranium Registries
Washington State University - Tri-Cities

Case No: 0002

ICD-9-CM and ICD-10 codes
Relation
ICD-9-CM Source
*
0

Description

434.91

Occlusion of cerebral arteries: Cerebral artery

occlusion, unspecified: with cerebral infarction

436

Acute, but ill-defined, cerebrovascular disease

414.00

599.0

564.7

424.1

515

492.8

ICD-10

Source

Description

I63.9

Cerebral infarction: Cerebral infarction, unspecified

Stroke, not specified as haemorrhage or infarction

I64

I25.1

N39.0

Other disorders of urinary system: Urinary tract

infection, site not specified

K57.9

Diverticular disease of intestine: Diverticular

disease of intestine, part unspecified, without
perforation or abscess

Other diseases of endocardium: Aortic valve

disorders

I35.8

Nonrheumatic aortic valve disorders: Other aortic

valve disorders

Postinflammatory pulmonary fibrosis

J84.1

Emphysema: Other emphysema

J43.9

Other forms of chronic ischemic heart disease: Of

unspecified type of vessel, native or graft
Other disorders of urethra and urinary tract:
Urinary tract infection, site not specified
Functional digestive disorders, not elsewhere
classified: Megacolon, other than Hirschsprung's

Chronic ischaemic heart disease: Atherosclerotic

heart disease

Other interstitial pulmonary diseases: Other

interstitial pulmonary diseases with fibrosis
Emphysema: Emphysema, unspecified

*0 = underlying cause of death; 1-7 = contributing causes of death in order of severity (1 = most severe)

Examiner's Notes
Bilateral diffuse pulmonary emphysema with areas of fibrosis
Mild focal pneumonitis
Cerebral cortical atrophy
Advanced coronary arteriosclerosis with insufficiency
Benign retention cysts of kidneys
Bilateral acute pyelonephritis
Cerebral arteriosclerosis
Chronic passive congestion of liver
Generalized arteriosclerosis
Hemorrhagic cystitis
Old healed myocardial infarction
Old proststectomy for carcinoma
Brain infarction
Frequent small strokes
ASHD
Urinary tract infection