Original communicationAccuracy in certification of cause of death in a tertiary care hospital – A retrospective analysis
Introduction
Birth and death are the two most important events in the life of an individual. A person's existence commenced with birth and ceases with demise. A person has a legal existence between the recorded timings of birth and death.1 A death certificate, or more appropriately a certificate for the registration of the medical cause of death is a document that enables the family of the deceased to register death. It also provides a measure of the relative contributions of different diseases to mortality which is vital for public health surveillance and for facilitating a wide range of research.2 Reliable information on deaths and their causes are vital for decision-makers as they provide information on the current health situation and allow monitoring the trends of the overall burden of diseases. Both the magnitude and distribution of disease burden are crucial to formulate policies, enable resource allocation for better addressing the health needs, and monitor the impact of health interventions on health outcomes.3 The data on the cause of death mentioned in the death certificates serve many purposes, such as assessment of the effectiveness of public health programs, providing a feedback for future policy and its implementation, improved health planning and management, and deciding the priorities of health and medical research programmes.4 Accuracy in certifying the cause of death is desirable at many levels—for the office of Population and Census Studies to provide reliable information to health planners, for families in understanding their inherited risks, and for individual doctors in preparing their performance review data.5 The Medical certification of cause of death [MCCD] scheme which is (basically) a part of International Statistical Classification of Diseases [ICD] and health related problems formulated by WHO is introduced to permit systematic recording, analysis, interpretation and comparison of morbidity and mortality data collected in different countries or areas at different times.4 Still, death certification continues to be poorly performed despite different recommendations and increased education at undergraduate and post graduate levels. There are multitude of reasons for inaccuracies in certification which include diagnostic errors, omissions, coding errors, death before completion of medical work up, unavailability of medical records, misunderstanding of certification process, and complexity of sorting out causal sequence that led to death when multiple diseases are involved.6 The cause of death includes any disease or injury responsible to initiate a chain of events incompatible with life resulting in death of a person.7
This study intends to evaluate the completeness and accuracy of Medical Certification of Cause of Death in our institution and to suggest necessary corrective measures to improve the completeness and accuracy of filling of MCCD form with the goal to improve the overall quality of Medical Certification of Cause of death.
Section snippets
Materials and methods
This retrospective study was carried out in Kalinga Institute of Medical Sciences, a tertiary care teaching institute in Bhubaneswar. The case records of patients who had expired from January 2012 to December 2012 along with the attached death certificate were retrieved from the Medial Record Department (MRD). The standard format used for medical certification of cause of death for hospital in- patient deaths confirms to the rules made by the Indian Government. Form No. 4 (Fig. 1).4The data
Result
A total of 151 case records along with the attached death certificates were evaluated for this study. Maximum numbers of certificates were issued to patients in the extremes of ages. The age group of less than 10 years constituted 42 (27.82%) cases while 46 (30.46%) cases fell in the greater than 60 years age group (Table 1). In terms of sex distribution 60.26% of those who died were males and 39.74% were females. The preliminary component of the death certificate such as full name of the
Discussion
Correct reporting and registration of the cause of death play a very important role in proper health program planning and delivery of health care. We have observed that the death rate was high (27.82%) among the pediatric population of <10 years which correlates well with the study by Raje8 & Wilkins.9 This high death rate may be explained by the fact that the hospital caters to a large section of population who are underprivileged with inadequate access to basic health facilities, and being a
Conclusion
Medical certificate of death is an important aspect of documentation following the death of an individual. It is a legal as well as ethical responsibility of the doctor to issue medical certificate of cause of death based on International Classification of Diseases. A lot of perplexity exists in the minds of medical fraternity about the correct way of filling the certificate of death. In our study of only 151 cases the results highlight that most of the certificates were inaccurate and
Ethical approval
Ethical clearance was obtained from the institutional ethical committee.
Funding
None.
Conflict of interest
Nil declared.
Acknowledgment
We are grateful for the information provided by Staff of MRD Kalinga Institute of Medical Sciences Hospital & Dr. Debajyoti Mohanty Associate Professor Dept. of Surgery AIIMS Raipur for his valuable suggestions during preparation of the manuscript.
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Cited by (20)
Quality of death certification based on the documented underlying cause of death: A retrospective study
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2020, Journal of Forensic and Legal MedicineCitation Excerpt :In all, 107 respondents (46.7%) responded that deaths outside the hospital should require postmortem inspection and only deaths in the hospital should require a doctor's report, 71 (31.0%) stated that the coroner system should be used only when the doctor asks for it, regardless of the place of death, 24 (10.5%) said that coroner system should be used only for deaths outside the hospital, 20 (8.7%) answered that they wanted to use a coroner system in all type of deaths, 5 (2.2%) said they did not need a coroner system, and 2 (0.9%) did not answer. Studies on the accuracy and errors of DCs have been published in many countries.8–11 Errors in the DC and PECs written by doctors in South Korea have been reported in some studies.12,13
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2019, Journal of Heart and Lung TransplantationCitation Excerpt :Missingness was high for the HRQOL data, resulting in a select and small sample for analysis; however, in patients with a recorded death, location of death was missing in only <2% of the cohort. Finally, out-of-hospital deaths were not able to be further refined, despite the fact that deaths in nursing facilities, hospice, and home have important differences.21 In conclusion, patients with LVADs die most commonly in the hospital, but beyond a year after implant nearly a third die out of the hospital, potentially away from specialty teams and trained experts.
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2015, Forensic Science InternationalCitation Excerpt :We suggest that eye examination and radiological study should be performed routinely in children autopsy. Post-mortem medico-legal investigation with toxicological examination and complete forensic autopsy are important in the determination and classification of possible non-natural child deaths [30–32]. In conclusion, the present study demonstrated patterns of age distribution, gender distribution, relationships of the offender(s), injury types, anatomical distribution of injuries, mechanisms of death, and causes of death among childhood homicides in Taiwan.
B-learning training in the certification of causes of death
2015, Journal of Forensic and Legal MedicineCitation Excerpt :This experience, based on the introduction of a blended learning model of training, has been both positive and effective. The results will improve the quality of certifications24 and the use of death-based indexes, such as the Spanish National Index of Deaths,25 which will, in turn, promote basic biomedical research and/or clinical or applied research on Public Health, such as the assessment of health prevention and/or attention in the different Health Systems. It will also be useful to assess the multicausality of diseases, because its study is not possible with the current model of certification, unless all the morbid or pathological processes associated or related with the underlying or basic cause are taken into account and assessed in the section of Other Processes.19,20