Ascertaining Cause of Death in a
Complicated Case
In actual practice, death certification may be relatively straightforward in certain cases and complicated in others. If a person has died because of a single condition such as malaria or tuberculosis or stroke, then the underlying cause of death is pretty straightforward -- it is malaria or tuberculosis or stroke respectively. Very often, individuals will have multiple disease conditions.
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The cause of death depends on the biologically plausible sequence of events
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Three case scenarios differing in the terminal sequence of events are as follows
Example 1: Case scenario
An adult who is a smoker has ischemic heart disease, myocardial infarction, diabetes, hypertension, stroke, COPD and pneumonia.
When this person dies, what is the single underlying cause that his death will be attributed to ?
Multiple terminal sequence of events leading to death
| If he deteriorated because of the stroke and subsequently developed pneumonia and then died. The terminal sequence of events would appear as in Case 1 | If on the other hand, it was COPD which worsened his terminal condition following the development of penumonia which triggered an acute exacerbation of COPD and then he died, it would appear as in Case 2 | If it was Myocardial infarction which caused his death then the terminal sequence of events would appear as in Case 3 |
|---|---|---|
| Case 1 | Case 2 | Case 3 |
| Death Pneumonia Stroke |
Death Acute exacerbation Pneumonia COPD |
Death Myocardial Infarction |
If the terminal sequence of events leading to death was:
| Case 1 | Case 2 | Case 3 |
|---|---|---|
| Death Pneumonia Stroke |
Death Acute exacerbation Pneumonia COPD |
Death Myocardial Infarction |
| Here, Stroke is the Underlying Cause of death |
Here, COPD is the Underlying Cause of death |
Here, MI is the Underlying Cause of death |
If the terminal sequence of events leading to death was:
| Case 1 | Case 2 | Case 3 |
|---|---|---|
| Death Pneumonia Stroke |
Death Acute exacerbation Pneumonia COPD |
Death Myocardial Infarction |
| Here in Case 1, all other conditions not in the disease pathway (such as hypertension, diabetes, IHD, MI, and COPD) should be listed as Contributory causes |
Here in Case 2, all other conditions not in the disease pathway (such as hypertension, diabetes, IHD, MI, and Stroke) should be listed as Contributory causes |
Here in Case 3, all other conditions not in the disease pathway (such as hypertension, diabetes, Stroke and COPD) should be listed as Contributory causes |
To be able to fill in a death certificate accurately, it is also very important to have good knowledge of standard terminologies that are commonly used during death certification.
Your next exercise is on standard terminologies in death certificate
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Ascertaining Cause of Death in a Complicated Case
e-MCCD M1U2LA5
By drkavya1
e-MCCD M1U2LA5
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