Errors in the certification of neonatal death

Area of Science:

• Perinatal mortality
• Neonatal death certification
• Public health surveillance

Background:

• Accurate death certification is crucial for understanding mortality trends and informing public health interventions.
• The perinatal death certificate (PDC) is the primary tool for recording causes of neonatal deaths.
• Previous studies suggest potential inaccuracies in death certification processes.

Purpose of the Study:

• To evaluate the accuracy of the perinatal death certificate (PDC) for neonatal deaths.
• To identify common sources of error in the certification of neonatal deaths using the PDC.
• To compare PDC data with comprehensive clinicopathological summaries (CPS).

Main Methods:

• Retrospective review of 179 neonatal deaths over a 7-year period.
• Comparison of causes of death listed on the PDC with those determined by a clinicopathological summary (CPS).
• Analysis of discordancies, including incorrect classification and sequencing of causes.

Main Results:

• The main causes of death between PDC and CPS were concordant in only 58% of cases (103/179).
• Significant discordancies were observed in 42% (76/179) of neonatal deaths.
• Errors included incorrect sequencing of main/other causes (23%), listing non-pathological conditions as primary causes (66%), and incorrect pathological diagnoses (11%).
• Lack of autopsy/laboratory data contributed to 13-27% of classification errors.

Conclusions:

• The accuracy of the PDC is compromised by sequencing errors and misclassification of causes of death.
• Incomplete information, particularly pending laboratory and autopsy results, significantly impacts certification accuracy.
• Improving PDC accuracy to 91% concordancy is achievable by correcting cause sequencing, prioritizing pathological conditions, and integrating all available clinical data.