Cross-tabulations between data variables (eg, age group, incident type, contributory factor, and incident outcomes), and between incident codes and contributory factor codes, will help to identify priorities (eg, vaccine errors in children) and clusters of common reported contributory events or factors for further inquiry by thematic analysis (Stage 3).
We classified deaths as due to CJD if the codes 046.1 (ICD-9) or A81.0 (ICD-10) were listed as either the direct or contributory cause (events = 65).
Until recently, there was limited convincing experimental evidence for epigenetic transgenerational effects in mammals and most studies were of maternal origin, where it can be argued that contributory in utero events confound data interpretation.
However, many incidents may not be reported or may not be reported in enough detail regarding contributory factors and preceding events [ 19, 20], or may contain inaccurate information.
A classification system, aligned with the World Health Organization International Classification for Patient Safety, was developed that incorporates multiple coding frameworks and rules for the application of codes to characterise the sequence of events and contributory factors leading to patient safety incidents.
96 Contributory factors underlying adverse events show them having a high commonality internationally, 97 and developing a similarly universal taxonomy and procedure for analysing patient complaints would allow for international learning and benchmarking (eg, at present consensus is often lacking between studies on the concepts used to analyse complaints).
(e) Case studies reporting contributory factors of a specific adverse event (eg, Chassin and Becher 26 ).
93 95 For example, systematic frameworks have been developed to standardise the identification and analysis of contributory factors leading to adverse events.
The risk of an individual is determined by the specific combination of events that hit contributory loci, in combination with other genetic and environmental risk factors.
