Errors in death certificates are classified into:

 

1. Technical/Clerical Errors

 

 

 

2. Certification Errors

Technical errors happen at the top and bottom of the death certificate

Certification errors happen in Part 1 and Part 2 of the death certificate

Technical/Clerical errors can happen in the top part of the certificate

Technical/Clerical errors can happen in the bottom part of the certificate also

Certification errors happen in Part I and Part II of the certificate

1. Technical/Clerical Errors include:

Technical or Clerical errors
1. Filling wrong form (eg. Stillbirths/ brought-dead being filled in the form meant for institutional deaths)
2.Wrong patient identifiers
3.Certifying physician details missing/incomplete
4.Not removing bottom portion for the relatives

Technical/Clerical errors that happen in the top part of the certificate include:

1. Filling wrong form     (eg. Stillbirths or brought-dead being filled in the form meant for institutional deaths)
2.Wrong patient identifiers

Technical/Clerical errors that happen in the bottom part of the certificate include:

3.Certifying physician details missing/incomplete
4.Not removing the bottom portion for the relatives

2. Certification Errors - Based on the type of error, this can be further                                                                 classified into: 

Type of Error
Major Error

1.Mechanism of death listed without an underlying cause

2.Improper sequencing

3.Competing causes of death
Minor Error

1. Abbrevations

2.Absence of time intervals

3.Mechanism of death           followed by a legitimate     underlying cause of death

These errors will be described in the next set of real death certificates filled in hospitals.

The errors in this certificate are:

Errors in this certificate -

1. Competing causes of death

2. Use of abbreviations

Cause of death written on the last line of the certificate [1(c)] is Underlying CoD. Here, in 1(c),the competing causes of death include low birth weight, RDS, perinatal asphyxia, ARF,RDS etc. It is important to write a single CoD and not multiple causes as Underlying CoD.

The errors in this certificate are:

Errors in this certificate -

 

1. The entry in line (a) is illegible

2. ?diagnosis is  acceptable in the hospital while the              person is still alive; but once death has occurred,              clinical judgement is to be used to arrive at a                      single probable cause of death and therefore ?                    mark is not needed

The error in this certificate is:

Error in this certificate -

 

1. The entry in line (a) is illegible

 

The errors in this certificate are:

Errors in this certificate -

 

1.  Incomplete details of accident

2. Use of abbreviations

The error in this certificate is:

Error in this certificate -

If only a single diagnosis is written, that will be taken as the underlying CoD [i.e. the last filled line among lines a, b or c in Part I is considered the uCoD]. So in this example, septicemia is the only filled diagnosis.                                        Septicemia is a non-specific cause (or) only an immediate CoD and not underlying CoD. For the death certificate to be valid/complete, the underlying CoD should be filled in line b or line c below.

The error in this certificate is:

Error in this certificate -

 

This is an example of Major error : Mechanism of death listed without an underlying cause. Failure to construct a chronological sequence of events and listing a mechanism/mode of death as the CoD (underlying, intermediate and immediate) is not useful.

The errors in this certificate are:

Errors in this certificate -

 

1. ? Brain cannot be a uCoD

2. Brain causing intracerebral hemorrhage causing chronic         bronchitis leading on high BP, IHD & DM is not a                     biologically-plausible sequence of events

3. High BP, IHD & DM are competing causes of death (more       than one disease cannot be listed on same line; each                 disease should be listed on a separate line); IHD should be     listed in Part 1 while DM & HT should be listed in Part 2​  

The error in this certificate is:

Error in this certificate -

 

While the intermediate and immediate causes of death have been listed, the underlying cause (whether road accident or slip & fall on the same surface or fall from a height or crush injury, etc) has not been identified as uCoD in line c of Part I

The errors in this certificate are:

Errors in this certificate -

 

1. Competing causes  with no biologically-plausible             sequence of events

2. Diabetes to be listed in Part 2

The errors in this certificate are:

Errors in this certificate -

 

1. Wrong sequence

2. Use of abbrevation

The error in this certificate is:

Error in this certificate -

 

Mechanism of death with no Underlying Cause of death

This is a good example to show that 'Burns' is not a natural cause of death ; but should be checked as one of 2 to 5 under manner of death.

Lessons from previous examples

  • These wrongly filled examples show us that these death certificates are not useful to:

 

  • If untimely deaths are to be prevented, the chain of events have to be interrupted or a cure initiated at some intermediate point

 

  1. Either the government/health authority in terms of identifying the causes of death in these hospitals in a region   
  2. Or the doctors in terms of identifying the sequence of events for intervention at specific points along the biologic pathway with appropriate diagnostic/therapeutic interventions


  • The public health objective is to prevent the precipitating cause from operating and hence the relevance of the underlying cause

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