Standard
terminologies
in Death
Certification
Let us define
A. Physicians
a.Attending Physician
b.Certifying Physician
B.Cause of Death
a. Underlying
b. Immediate
c. Antecedent
A. Physicians
a.Attending Physician
b.Certifying Physician
- Physician attending to the patient prior to death or during the course of the terminal illness
- Physician completing Cause of Death statement on death certificate (may be the attending physician, or not)
- Death should preferably be certified by the attending physician; that is, the attending physician and the certifying physician should be one and the same
- However, in several instances, this may not be possible – the certifying physician does not have recourse to all the medical details of the patient whose death she/he is certifying – in these instances, best clinical judgment is to be made use of
Defining
B.Cause of Death
a. Underlying
b. Immediate
c. Antecedent
|
Underlying cause of death |
The condition that triggered the chain of events leading to death; temporally, the most remote condition; etiologically specific |
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Antecedent (or intermediate) cause of death |
A disease or condition that occurred as a result of the underlying cause of death but was not the final complication or immediate cause of death |
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Immediate cause of death |
The final complication resulting from the underlying cause of death, occurring closest to the time of death and directly causing death |
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| Term | Definition |
|---|---|
|
|
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| Immediate cause of death | The final complication resulting from the underlying cause of death, occurring closest to the time of death and directly causing death |
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Antecedent (or intermediate) cause of death |
A disease or condition that occurred as a result of the underlying cause of death but was not the final complication or immediate cause of death |
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|
Underlying cause of death |
The condition that triggered the chain of events leading to death; temporally, the most remote condition; etiologically specific |
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In India, according to hospital death certificates,
the most common cause of death is,
“Cardio-respiratory arrest”
This is not a cause of death but a
Mode/Mechanism of death
Mode or mechanism of death
For all disease conditions, the end point of death is because of the heart or lungs or both stopping functioning in an individual.
Therefore cardiac arrest or cardio-respiratory arrest are the final mechanism of death and is not to be coded as the underlying cause of death (uCoD)
Cause vs Mode of death
The sequence of events leading to death is likely to be:
| Disease |
|---|
| Complication |
|---|
| Cardio-respiratory arrest |
|---|
| Death |
|---|
Cause vs Mode of death
In the case of cardiac arrest or cardio respiratory arrest
- the disease should be coded as the underlying CoD
- The complication should be identified as the immediate CoD
- And cardiorespiratory arrest is called the final mechanism of death
| Disease |
|---|
| Complication |
|---|
| Cardio-respiratory arrest |
|---|
| Death |
|---|
Some common conditions that
are not causes of death
| Term | Definition |
|---|---|
|
Mode OR Mechanism of death |
A derangement or disturbance by which a cause of death exerts its lethal effect (e.g., cardiac arrest, respiratory arrest, cardio respiratory arrest); must not be used as an underlying cause of death |
| Term | Definition |
|---|---|
|
Non-specific condition |
A derangement or disturbance that has more than one possible cause (e.g., sepsis, hemorrhage, heart failure, renal failure,multi-organ failure) must not be used as an underlying cause of death |
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Non-specific conditions such as septicemia, renal failure or respiratory failure must not be identified as the underlying cause of death
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They are the consequence of some other disease entities and therefore they may be coded as the immediate cause of death; in all such cases a causal pathway must be constructed to identify the disease that led to these end-processes
| Term | Definition |
|---|---|
|
Risk factors |
Underlying determinants but not cause of death (eg. Smoking, alcoholism, etc.) must not be used as an underlying cause of death |
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Though smoking or alcoholism may have been underlying risk factors for the development of diseases subsequently, these behaviors are identified as risk factors and not as the underlying causes of death
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The biological abnormality arising as a consequence (eg, cancer, ischemic heart disease, alcoholic liver disease, etc.) should be identified as the underlying cause of death and not these risk behaviours per se
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World Health Organisation(W.H.O.) also makes the suggestion on the following conditions not being preferred as underlying causes of death but to be considered as risk factors
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For newborns :
1.Prematurity
2.Low Birth Weight
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For children :
1.Malnutrition
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For adults :
1.Hypertension
2.Diabetes
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This means that in a person with a long-standing illness such as diabetes, the complication that triggered the sequence of events leading to death (such as may be diabetic nephropathy) should be listed as the underlying CoD rather than the diabetes per se
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Similarly in children, the illness arising in a child with malnutrition (for eg diarrhea or pneumonia) should be coded as the UCoD rather than the malnutrition
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The above conditions may be used only in those instances when no other complications/sequelae are known to have occurred in the particular individual
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This reasoning is based on the fact that the above conditions are so very common that they would virtually then be listed as the UCoD in almost all of the adults/children/newborns
Learning from this activity
-
Death should preferably be certified by the attending physician; instances where this is not possible, the death certification is based on the best clinical judgment of certifying physician
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It is important to understand the differences between what is the underlying cause-of-death and what cannot be included as underlying cause-of-death The latter includes
a. mode and manner of death
b. non-specific condition and risk factors
Summary of Unit 2
- It is important to differentiate between the Mode, Manner and Cause of death in an individual
- On a death certificate, only the Cause of death and Manner of death are to be filled and not the Mode of death
- Identifying the correct Cause-of-Death is important and this is possible only through the construction of a chronological sequence of events leading to death
- The should preferably fille dby the attending physician
- Mode of death, non-specific factors and risk factor s cannot be considered as Underlying cause -of death
- Your next Unit deals with
- ‘Death Certificate - Parts, types and how to fill’