Real examples of death certificates filled from
hospitals
The errors in this certificate are
- Competing causes of death
- Use of abbreviations
The errors in this certificate are
- Latter part is illegible
- ?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
- It is illegible
The errors in this certificate are
- Incomplete details of accident to code
- Use of abbrevations
The error in this certificate is
- 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
- 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
- ? Brain cannot be a uCoD
- Brain causing intracerebral hemorrhage causing chronic bronchitis leading on high BP, IHD & DM is not a biologically-plausible sequence of events
- 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
- 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
- Competing causes with no biologically-plausible sequence of events
- Diabetes to be listed in Part 2
The errors in this certificate are
- Wrong sequence
- Use of abbrevation
The error in this certificate is
- 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
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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
- The government/health authority in terms of identifying the causes of death in these hospitals in a region OR to
- The doctors in terms of identifying the sequence of events for intervention at specific points along the biologic pathway with appropriate diagnostic/therapeutic interventions
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The public health objective is to prevent the precipitating cause from operating and hence the relevance of the underlying cause
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