NRAD methods

Who will be included?

Every death from asthma in the UK during the one-year study period – 1 February 2012 to 31 January 2013 – will be included. The NRAD project team will ask to be notified of:

A subject with one of the following two criteria (mandatory):

• patient had treated or untreated asthma or
• the fatal attack was the first attack of asthma

and any of the following:

• death certified as being due to asthma (ICD-10 J45-J46) in part 1 of the medical certificate of the cause of death (MCCD)
• post-mortem diagnosis of asthma as cause of death
• clinician diagnosis of asthma as probable cause of death
• death classified as being due to anaphylaxis (ICD-10 T78.2)
• ONS classification of asthma as underlying cause of death (ICD-10 J45-J46)
• ONS classification of anaphylaxis as underlying cause of death (ICD-10 T78.2)

The individual notifying the NRAD will also be asked to comment on the likelihood of whether asthma as cause of death was:

i) highly likely
ii) moderately/quite likely
iii) difficult to define

Phases of data collection

The project comprises three phases designed to examine the management and care of patients who have died from asthma.

1. Basic notification information from various sources and completion from Form 1 by clinicians or by the NRAD team (using information obtained from ONS) as per agreed inclusion criteria (above)
2. Core data collection from hospitals (Forms B1 and B2) and GP practices (A1 and A2) on all patients who meet the above inclusion criteria
3. A confidential enquiry panel review of all asthma deaths including:

• reliability of diagnosis
• preventable causes of the deaths
• overall clinical management compared with agreed national standards
• an associated academic analysis to identify trigger factors
• recommendations for improving care of asthma patient.
  

Which cases will be reviewed at a confidential enquiry panel?

• cases where notifying clinicians are confident either on notification or subsequent discussion with the NRAD project team that asthma was the cause of death
• cases considered ‘difficult to define’ by notifying clinicians.

 How will data be collected?

Data collection will take part in two stages:

1. Basic notification data (Phase 1) – this will be collected shortly after the death (or as soon as possible after notification) via the 'Form 1 - notification summary'. This form will be completed by various sources (clinicians, trusts, pathologists, ONS).   
2. Core data (Phases 2 and 3) – following notification primary and secondary care professionals involved in the patient’s care will be sent an ‘audit’ questionnaire to complete (Forms A1 and A2 (primary care) and B1 and B2 (secondary care)).
   
   Photocopied extracts of case notes will also be requested for these cases for the confidential enquiry review panels.
   
   
3. Core data (Phases 2 and 3) – multidisciplinary panels of clinicians (Phase 3) will be convened at face-to-face meetings to scrutinise, summarise, conclude and make recommendations on all of the cases included in this review.
   
   Photocopied extracts (or computer printouts) of case notes will also be requested for the purpose of data validation against completed audit questionnaires and for use as anonymised resources during the multidisciplinary confidential enquiries.