Real examples of death  certificates filled from

hospitals

The errors in this certificate are

  1. Competing causes of death
  2. Use of abbreviations

The errors in this certificate are

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

The error in this certificate is 

  1. It is illegible

The errors in this certificate are

  1. Incomplete details of accident to code
  2. Use of abbrevations

The error in this certificate is 

  1. 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. But this we know is only    an immediate CoD and 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

  1. Failure to construct a chronological sequence of events and listing a mode of death as the CoD (underlying, intermediate and immediate)

The errors in this certificate are

  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; IHD should be listed in Part 1 while DM & HT should be     listed in Part 2  

The error in this certificate is 

  1. 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

  1.  Competing causes  with no          biologically-plausible                    sequence of events
  2.  Diabetes to be listed in Part 2

The errors in this certificate are

  1.  Wrong sequence
  2.  Use of abbrevation

The error in this certificate is 

  1. 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

Learning from 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. The government/health authority in terms of identifying the causes of death in these hospitals in a region   OR  to
  2. 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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