[Certificates. Death certificates, accident and injury certificates; drafting and issuance. The requirements].
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Accidents↗
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Results for “DEATH CERTIFICATES”
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[Exercising care in filling out death certificates].
Death certificates of 1,432 dead persons being older than 1 year of the urban district of Gera (1987) were evaluated. 72.3% of the death certificates showed one or more mistakes. The average number of the mistakes was 1.8. The most numerous formal mistakes and such with regard to the contents were analyzed as well as conclusions were drawn for the further qualification of the coroner physicians and the improvement of filing in the death certificates.
Adolescent↗
Preventable factors and death certification in death due to asthma.
A 2 yr District-wide study was carried out to assess whether there were preventable factors in the management of patients dying from asthma, and also to assess the accuracy of death certification of asthma. Eighteen deaths occurred in which asthma was the certified cause of death. In 10, asthma was the actual cause of death. Due to inaccuracies of death certification, death was due to other causes in seven cases. In the remaining case it was not possible to differentiate between asthma and chronic obstructive airways disease. Among the 10 deaths from asthma the condition was considered to be mild in three. In three, death occurred too rapidly for help to have been available. Preventable factors were present in four cases. In three, either the patient, the doctor or both failed to appreciate the severity of the condition and the need for urgent help or hospitalization. The fourth patient had failed to seek any medical care. Many lives might be saved if patients and doctors treated severe breathlessness due to asthma with the same sense of urgency that chest pain suspicious of myocardial infarction is treated. Education is needed to improve both the clinical and post mortem accuracy of death certification. Both this and the management of asthma should be the subject of ongoing local audits.
Adult↗
Causes of death in Japanese diabetics. A 20-year study of death certificates.
Death certificates filed between 1960 and 1979 in Osaka, Japan were analyzed to study causes of death in diabetic patients. It was observed that diseases of the circulatory system increased continuously from 15.2% in 1960-1964 to 27.2% in 1975-1979. Cerebrovascular disease and disease of heart were the leading causes of death throughout the study period. The rate of increase was much faster for disease of heart than for cerebrovascular disease, and there was only a small difference between them as cause of death in diabetic patients at the end of the observation period. Malignant neoplasms, cirrhosis of the liver, and pneumonia and bronchitis increased, whereas tuberculosis decreased sharply according to age-adjusted mortality rate during the 20-year period. Analysis based on O/E ratios suggested higher risk of dying from ischemic heart disease, tuberculosis and cirrhosis of the liver in Japanese diabetics than in the general population in this country.
Aged↗
Death certificates, natural death, and alcohol. The problem of underreporting.
Previous studies have identified an apparent underreporting of alcohol-related natural deaths on death certificates. This survey consists of a review of death certificates in one urban county, and provides further evidence that alcohol-caused natural deaths are underreported by physicians who sign death certificates.
Alcoholism↗
Autopsies and death certification in deaths due to blunt trauma: what are we missing?
OBJECTIVES: To determine the frequency, body region and severity of injuries missed by the clinical team in patients who die of blunt trauma, and to examine the accuracy of the cause of death as recorded on death certificates. DESIGN: A retrospective review. SETTING: London Health Sciences Centre, London, Ont. PATIENTS: One hundred and eight deaths due to blunt trauma occurring during the period Apr. 1, 1991, to Mar. 31, 1997. Two groups were considered: clinically significant missed injuries were identified by comparing patient charts only (group 1) and more detailed injury lists from the autopsies and charts of the patients (group 2). OUTCOME MEASURES: Chart and autopsy findings. RESULTS: Of the 108 patients, 78 (72%) were male, and they had a median age of 39 years (range from 2 to 90 years). The most common cause of death was neurologic injury (27%), followed by sepsis (17%) and hemorrhage (15%). There was disagreement between the treating physicians and the causes of death listed on the death certificate in 40% of cases and with the coroner in 7% of cases. Seventy-seven clinically significant injuries were missed in 51 (47%) of the 108 patient deaths. Injuries were missed in 29% of inhospital deaths and 100% of emergency department deaths. Abdominal and head injuries accounted for 43% and 34% of the missed injuries, respectively. CONCLUSIONS: The information contained on the death certificate can be misleading. Health care planners utilizing this data may draw inaccurate conclusions regarding causes of death, which may have an impact on trauma system development. Missed injuries continue to be a concern in the management of patients with major blunt trauma.
Adolescent↗
The validity of death certificates: routine validation of death certification and its effects on mortality statistics.
The 3478 death certificates (7.1% of all annual death certificates) of this study comprise those national death certificates in 1995 submitted for validation to the panel representing both medical and nosological expertise. As such, it is highly selected and represents, from the nosological point of view, the most inconsistently filled-in portion of Finnish death certificates. The routine validation procedure is essentially based on exploitation of the extra medical information, i.e. the case history, on the Finnish death certificate form. Altogether, 2813 (80.9%) out of 3478 certificates could be adjusted at the primary panel session; the rest required further clarification. The re-assignment of cause of death by the panel and the impact of panel adjustments on the national mortality statistics is assessed here by comparing the initial death certification and the finally registered underlying cause of death grouped into ICD-9 major categories with special reference to the subcategories of neoplasm, cardiovascular disease (HVD) and unnatural death. A statistically significant decline (p<0.0001) in deaths, both in the category of symptoms, signs and ill-defined conditions and in the pulmonary circulation disease subcategory of HVD with 37.6 and 35.1%, respectively, was observed. The decrease of 11.1% in the benign or NUD neoplasm subcategory and the increase of 8.6 and 7.0% in the categories of endocrine disease, and musculo-skeletal and connective tissue disease, respectively, are essential observations as to the quality of the cause of death register. The effect on the HVD major category was practically nil. At the HVD-subcategorial level, a decrease of 14.0% for diseases of the veins and lymphatics and other circulatory diseases and an increase of 3.5% for hypertensive diseases (HYP) were the two next most obvious alterations to the diseases of the pulmonary circulation, but were without statistical significance. For ischaemic heart disease and other subcategories, the effects were minor. The unnatural deaths as a whole increased in the final statistics with only 0.9%. In the study data, categorial changes ranged from the decrease of 75.2% for symptoms, signs and ill-defined conditions to the increase of 77.3% for endocrine diseases. In conclusion, the Finnish death certificate form, death certification practices and cause of death validation procedure seem to serve the coding of causes of death for mortality statistics appropriately. The results of the study form a relevant reference background to evaluation of epidemiological studies on mortality.
Abstracting and Indexing↗
[Modification of forms of birth certificates and death certificates].
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Birth Certificates↗
[Death certificates and death causes].
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Cause of Death↗
Why are a quarter of all cancer deaths in south-east England registered by death certificate only? Factors related to death certificate only registrations in the Thames Cancer Registry between 1987 and 1989.
This paper describes the results of a study set up to investigate factors associated with the high proportions of 'death certificate only' registrations (DCOs) for all cancers registered in south-east England between 1987 and 1989 and to identify those which might be subject to registry intervention. DCOs as a proportion of all registrations (n = 162,131) were analysed by age, sex, district of residence, place of death and survival. DCO registration ratios (standardised for age and sex) were then derived for each of the 56 districts in the Thames Regions. A multiple logistic regression model was generated to estimate the effect of age at diagnosis, tumour survival and patient sex on final source of registration. To minimise the number of dummy variables needed, each of the 56 districts was ranked into quartiles: quartile 1 contained the 14 districts with the lowest age- and sex-standardised ratios for DCO registrations and quartile 4 comprised the 14 districts with the highest DCO ratios. Final source of registration was treated as a binomial trial (case notes or death certificates). The significance of associations was measured using the deviance difference as an approximate chi-square statistic. The effect of each variable on source of registration was estimated as an odds ratio. Interaction terms were also fitted. To estimate the effect of place of death on DCO registrations, a second model was generated for deceased patients only (n = 98,455, adding 'place of death' to the list of explanatory variables already used. A further interaction term was fitted to account for interaction between place of death and district quartile of residence. Around 24% of all patient deaths were registered as DCOs by the Thames Cancer Registry between 1987 and 1989. Of these, 40.9% died in an acute NHS hospital setting, 37.1% died at home, 10.4% died in hospices and 3.4% died in non-NHS hospitals. Increasing age, decreasing survival, district of residence and place of death were positively associated with death certificate registrations. The district effect was sustained in the regression model with significant positive associations shown for DHA quartile of residence. In the deceased group of patients, both district of residence and place of death were independent predictors of DCOs. Death occurring outside the acute NHS hospital setting increased the odds of being a DCO within and across district quartiles. DCOs could be reduced by better case ascertainment in some districts.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
[Comparability of the data presented in the medical death certificate and the death rate statistics index].
It having been impossible to use the Death Rate Statistics Index for analyzing the death rate in the city of Seville for 1985 and this Index having been substituted by the Medical Death Certificate has lead us to carry out this study to compare the data reflected in these two documents and determine the extent to which the Medical Death Certificate conforms to the Death Rate Statistics Index, used officially, and its validity. The results show that both documents tally to a great degree, the DRSI providing somewhat more information with regard to the process leading up to the deaths, this having led us to decide to make the death rate analysis for 1985 in Seville by using the Medical Death Certificate as the document on which the information will be based.
Cause of Death↗
The proposed death certificate for South Africa. Part I. Death certificate description.
An altered 'Cause of Death' certificate is proposed. The major changes involve the use of the international format for certification of death and provision for collection of extra data, i.e. estimated age at death, sex, population group and, where relevant, the mass of an infant at birth. The new format will facilitate improved data collection and the certificate will stand international comparison.
Data Collection↗
Accuracy of death certificates in neonatal deaths.
Death certificates of neonates were compared with detailed clinical and pathological information provided for a national neonatal mortality survey. The systematic method of assigning the cause of death to one of seven broad categories in the survey found complete agreement with the underlying cause of death on the death certificate in 83 per cent of cases (274/330). There was only a minor disagreement involving clinical opinion in a further 6.7 per cent (22). The reasons for disagreement in the remaining 10.3 per cent (34) were examined. In the majority of instances, 6.0 per cent (20), the fault lay with the certifying doctor who provided inadequate or inaccurate information on the death certificate or who, in providing all the information, appeared to be ignorant of coding rules. In 1.2 per cent (4) the fault lay with coding inaccuracies or misapplication of coding rules in failing to select the underlying cause in a correct sequence of clinical events. In the remaining 3.0 per cent (10) of cases the rules governing the survey did not follow the WHO coding rules.
Cause of Death↗
Diagnosis on death certificates of sudden death due to ischemic heart disease.
This study was undertaken to evaluate the quality of diagnoses of sudden death (SD) caused by ischemic heart disease (IHD) on death certificates. A random sample of 10% (100 cases) was drawn from all such deaths which occurred in 1970 among Oklahoma City residents. The medical records of each case were reviewed and the quality of the diagnosis was rated, by the use of predetermined standard criteria, as confirmed and valid or unconfirmed and invalid. Among 100 IHD deaths, SD constitute 45%. Of these SDs, 18% were unobserved, without information as to the manifestations of the attack or the interval from onset of symptoms to death. According to criteria of the American Heart Association and WHO Expert Committee, the diagnosis in this 18% was unconfirmed and invalid. Thus there is insufficient quantitative evidence to justify the use of SD, as found on death certificates, as an indication of frequency of ischemic heart disease.
Coronary Disease↗
Analysis of the sensitivity of death certificates in 440 hospital deaths: a comparison with necropsy findings.
BACKGROUND: There is current heightened public interest in issues surrounding death certification and necropsy. The present study was initiated to determine the accuracy of death certification in providing a correct diagnosis in a series of adult deaths occurring in hospital, all of which were followed by a necropsy. METHOD: We examined a series of 440 consecutive adult hospital necropsies performed at Addenbrooke's Hospital, without prior knowledge of the cause of death on the death certificate. The major causes of death at necropsy were subdivided on the basis of organ systems and subsequently compared with the cause of death stated on the death certificate. RESULTS: There were 448 stated causes of death on the death certificates, compared with 508 causes recorded at necropsy. The overall sensitivity of the death certificate in predicting an individual cause of death was 0.47, with sensitivities ranging from 0.90 in the neurological system to 0.28 in the cardiovascular system, and the sensitivity for all malignant causes of death was 0.65. No significant overall differences were noted in respiratory, gastrointestinal, malignant, and "other" systems when comparing causes of death on the death certificate with those at necropsy. CONCLUSIONS: There is a substantial discrepancy between the diagnosis given on death certificates compared with that at hospital necropsy. This paper discusses the importance of clinicopathological concordance and emphasises the importance of the necropsy in death certification.
Adult↗
Mind your manners. Part I: History of death certification and manner of death classification.
Every death is unique, but deaths also share similar features that allow them to be grouped into categories. Since its initial description over 800 years ago, the position of coroner has been charged with the determination of manner of death. This determination has been made by examination into the circumstances surrounding death and of wounds on the surface of the body. Over the years, physicians have gained sufficient understanding of the body such that the autopsy became an important part of a death investigation. With additional time, laws were changed so that individuals charged with the determination of manner of death were required to have appropriate training. Death certification is the means by which deaths are grouped together according to similar characteristics. The practice of death certification has led to effective public health programs and the advancement of medical science. The addition of manner of death to the death certificate is an American contribution to vital statistics registration. The purpose of the autopsy report differs from that of the death certificate; the report fully addresses the unique aspects of a death, while the certificate captures the essence of the circumstances surrounding death in a few words.
Autopsy↗
Pitfalls in the use of death certificates for assessing cause of death: a study of tonsil carcinoma patients.
A study was undertaken to determine the accuracy of underlying cause of death as stated on the death certificate for patients treated at Mallinckrodt Institute of Radiology (MIR) for carcinoma of the tonsil. The sample consisted of 110 patients who were treated between 1953 and 1976 and who subsequently died; all patients were seen by a physician within 3 months of their death. Death certificate cause of death was compared with the cause of death as stated in the MIR patient record. Death certificates detected 42.5% of the deaths due to tonsil carcinoma recorded in the hospital record, and detection was found to correlate with time between treatment and death. Of the deaths reported on the death certificate as due to tonsil carcinoma, 91% were confirmed by the hospital record to be correctly reported. Overall agreement in assignment of cause of death between the hospital record and the death certificate was 59%, and was significantly affected by stage of disease at diagnosis. This review underscores the low reliability of death certificates and raises a serious question concerning the use of this information for patients who are registered in clinical trials without additional documentation of tumor extent and cause of death.
Aged↗
Comparison of death certificate occupation and industry data with lifetime occupational histories obtained by interview: variations in the accuracy of death certificate entries.
This study compares usual and recent occupation and industry data from lifetime work histories obtained by interview with death certificate entries for occupation and industry for 2,435 persons diagnosed with cancer. Match rates are calculated as the percent of death certificate occupation and industry entries that were confirmed by interview data and are compared for exact 3-digit 1980 U.S. Census Bureau occupation and industry codes and for groups of these codes. The overall match rate for individual usual occupation codes was 47.9% and for exact usual industry codes it was 61.8%. Significant differences between the interview data for usual occupation or industry and the death certificate entry were observed by race and gender, marital status, number of years worked, and occupation and industry groups and by age for industry. Misclassification or overreporting of occupation and industry data on the death certificate ranged from 30 to 50% in this study. Our results suggest that the utility of death certificate data for investigations into the occupational risk factors for cancer may be quite limited.
Adult↗