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Problems with proper completion and accuracy of the cause-of-death statement
A E Smith Sehdev1, G M Hutchins
1Department of Pathology, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287-6901, USA.
Archives of Internal Medicine
|February 15, 2001
Summary
Accurate cause-of-death statements (CODs) on death certificates are crucial. This study found significant discrepancies between clinician and autopsy CODs, highlighting a persistent problem in mortality statistics.
Area of Science:
- Forensic Pathology
- Medical Statistics
- Public Health
Background:
- Mortality statistics rely heavily on death certificate accuracy.
- Clinicians at this institution provide cause-of-death statements (CODs) before autopsy.
- Separate CODs have been included in autopsy face sheets since May 1995.
Purpose of the Study:
- To compare clinical and autopsy-based cause-of-death statements (CODs) for accuracy.
- To assess the proper reporting of immediate, intermediate, and underlying causes of death.
Main Methods:
- Compared clinical and autopsy-based CODs for 494 cases (June 1995-February 1997).
- Utilized College of American Pathologists and National Center for Health Statistics guidelines.
- Evaluated accuracy based on established definitions of death causes.
Main Results:
- 41% of death certificates had improperly completed CODs.
- 24% of improperly completed CODs showed major discrepancies between clinician and autopsy findings.
- 49% of properly completed CODs still had disagreements on underlying or immediate causes.
Conclusions:
- The accuracy and reliability of cause-of-death statements remain a significant issue.
- Autopsies serve as the gold standard for verifying premortem diagnoses.
- Completing death certificates concurrently with postmortem examinations and amending them based on autopsy findings can improve accuracy.