{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T19:04:24Z","timestamp":1790103864150,"version":"4.0.1"},"reference-count":37,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"unspecified","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,10]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To classify causes of death in northern Tunisia in 2023 according to the International Classification of Diseases, 11th Revision (ICD-11) and ICD-10, and to compare the two classifications in a forensic context.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Descriptive cross-sectional study of causes of death in a forensic setting in 2023. Demographic data and causes of death were retrospectively extracted and coded using ICD-11 and ICD-10, applying ICD-11 post-coordination where relevant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A forensic medicine department in a university hospital in Tunis, Tunisia, accounting for eight northern governorates of Tunisia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>All deaths examined or autopsied during 2023 were included. Cases involving aborted fetuses, stillbirths, exhumed remains with death occurring before 2023 and skeletal remains were excluded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 2214 deaths were included, of whom 73.6% were male, with a mean age of 53.3 years. The most frequent ICD-11 chapters were External Causes (41.2%) and Diseases of the Circulatory System (32.8%). ICD-11 identified 216 unique underlying causes, compared with 219 using ICD-10. ICD-11 post-coordination was applied in 88.5% of cases, providing additional details for road traffic accidents, assaults and poisonings. Overall distributions were similar, but ICD-11 allowed a more specific coding of causes of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ICD-11 enhances medicolegal mortality reporting by improving specificity, flexibility and the ability to capture multiple circumstances of death. Its adoption will strengthen national mortality statistics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-121065","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:35:31Z","timestamp":1790102131000},"page":"e121065","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Forensic mortality in northern Tunisia in 2023: a cross-sectional study comparing ICD-11 and ICD-10 coding"],"prefix":"10.1136","volume":"16","author":[{"given":"Ons","family":"Hmandi","sequence":"first","affiliation":[{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"},{"name":"Department of Forensic Medicine, Charles Nicolle Hospital, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4009-3071","authenticated-orcid":false,"given":"Alaaeddine","family":"Marai","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"},{"name":"Department of Forensic Medicine, Charles Nicolle Hospital, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariem","family":"Zribi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"},{"name":"National Health Institute, Republic of Tunisia Ministry of Public Health, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nada","family":"Zoghlami","sequence":"additional","affiliation":[{"name":"National Health Institute, Republic of Tunisia Ministry of Public Health, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hajer","family":"Aounallah-Skhiri","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"},{"name":"National Health Institute, Republic of Tunisia Ministry of Public Health, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Allouche","sequence":"additional","affiliation":[{"name":"Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia"},{"name":"Department of Forensic Medicine, Charles Nicolle Hospital, Tunis, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"2026092211352450000_16.9.e121065.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12911-021-01501-1","article-title":"Public health utility of cause of death data: applying empirical algorithms to improve data quality","volume":"21","author":"Johnson","year":"2021","journal-title":"BMC Med Inform Decis Mak"},{"key":"2026092211352450000_16.9.e121065.2","unstructured":"National Academies of Sciences, Engineering, and Medicine. Health and Medicine Division, Board on Health Sciences Policy, Committee on Best Practices for Assessing Mortality and Significant Morbidity Following Large-Scale Disasters . A framework for assessing mortality and morbidity after large-scale disasters. Washington (DC): National Academies Press, 2020."},{"key":"2026092211352450000_16.9.e121065.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12911-021-01534-6","article-title":"ICD-11: an international classification of diseases for the twenty-first century","volume":"21","author":"Harrison","year":"2021","journal-title":"BMC Med Inform Decis Mak"},{"key":"2026092211352450000_16.9.e121065.4","unstructured":"Minist\u00e8re de la Sant\u00e9, Institut National de la Sant\u00e9 Publique . Le syst\u00e8me national d\u2019information sur les causes m\u00e9dicales des d\u00e9c\u00e8s: Statistiques nationales sur les causes de d\u00e9c\u00e8s en Tunisie 2021. Minist\u00e8re de la Sant\u00e9: Tunis; 2024. 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