Examples of Common Mistakes on Death Certificates

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1. Non-specific Causes - By far the most commonly encountered errors in cause of death statements are lack of an etiologic specific cause of death.

Example 1:
Non-specific Causes - By far the most commonly encountered errors in cause of death statements are lack of an etiologic specific cause of death.
In this case, nothing listed gives any indication of what disease or injury is responsible for this individuals condition. A brief review of his medical history shows this is a 49 man with hepatic cirrhosis from years of alcohol abuse. The Cause of death could be stated simply as

a. Terminal complications of hepatic cirrhosis days
b. Alcohol abuse years



Example 2:
In this example one immediately should question, why this person is having dysphagia? It turns out this 97 year old man is in the terminal stages of Alzheimer's disease, which should be added to line c.
In this example one immediately should question, why this person is having dysphagia? It turns out this 97 year old man is in the terminal stages of Alzheimer's disease, which should be added to line c.

Example 3.
Is the renal failure in this patient a complication of Diabetic nephropathy, Hypertension, ethylene glycol intoxication, immune complex glomerulonephritis? Etc. etc. A review of the medical records shows this 74 man has had 2 previous myocardial infarcts and has been treated for hypertension and diabetes for many years. His death should be certified as:

Is the renal failure in this patient a complication of Diabetic nephropathy, Hypertension, ethylene glycol intoxication, immune complex glomerulonephritis? Etc. etc. A review of the medical records shows this 74 man has had 2 previous myocardial infarcts and has been treated for hypertension and diabetes for many years. His death should be certified as:

a. renal failure weeks
b. hypertensive and atherosclerotic cardiovascular disease years

Part 2. Contributory factors: Diabetes Mellitus, type II

Example 4
This example gives no indication of the cause of the congestive heart failure. Is it due to Alcoholic cardiomyopathy?, Coronary artery disease? Pericardial adhesions from viral myocarditis? Or as end stage hypertensive disease? As it turns out this woman has severe calcific aortic stenosis which has resulted in congestive heart failure. Her death certificate should read:

This example gives no indication of the cause of the congestive heart failure. Is it due to Alcoholic cardiomyopathy?, Coronary artery disease? Pericardial adhesions from viral myocarditis? Or as end stage hypertensive disease? As it turns out this woman has severe calcific aortic stenosis which has resulted in congestive heart failure. Her death certificate should read:

a. congestive heart failure months
b. aortic stenosis years
c. dystrophic calcification years

2. To many causes

Example 5
This 90 year old man was found dead in his room during routine morning rounds. He was last known alive the previous evening with no acute complaints. The most logical clinical scenario was that he suffered an ischemic cardiac event and arrhythmia while he slept. The cause of death should be written as:

In this example, mechanisms of death (chronic and acute renal failure and congestive heart disease) are mixed in with etiologically specific causes of death(Ethanol abuse, Tobacco abuse, Atrial fibrillation, hypertension, abdominal atherosclerotic aneurysm, peripheral vascular disease and atherosclerotic cardiovascular disease) in no logical sequence. This 90 year old man was found dead in his room during routine morning rounds. He was last known alive the previous evening with no acute complaints. The most logical clinical scenario was that he suffered an ischemic cardiac event and arrhythmia while he slept. The cause of death should be written as:

a. ischemic cardiac arrhythmia (probable) minutes
b. Atherosclerotic coronary artery disease years

Part 2. Hypertension, Atrial fibrillation, Generalized atherosclerotic vascular disease, Chronic obstructive pulmonary disease (type unspecified), Tobacco and Alcohol abuse.

See also abbreviations and pronouncement of death


3. Putting the cart before the horse

Example 6
The way this example is written the patient's diabetes is due/ caused by dementia. This 85 year old woman with end stage dementia who has been diabetic for many years was found dead in bed on routine rounds. The death should be certified as:

The way this example is written the patient's diabetes is due/ caused by dementia. This 85 year old woman with end stage dementia who has been diabetic for many years was found dead in bed on routine rounds. The death should be certified as:

a. Dementia (Type unspecified)

Part 2. Diabetes mellitus.

Note: If the type of dementia is known or could be implied from the patients history Multiinfarct dementia complicating atherosclerotic cardiovascular disease, parkinsons disease or alzheimers disease it should be reported. If the cause is multifactorial then all causes may be listed

a. Dementia (vascular and Alzheimer's type)

alternatively

a. Dementia (multifactorial, see part 2)

Part 2. Alzheimer's disease; cerebral infarct due to thromboembolsim from atrial fibrillation

Example 7
The way this is written, the ovarian sarcoma was caused by a bowel obstruction. Clearly it is the opposite. Also intervals should increase in time as you get farther from the immediate cause of death.

The way this is written, the ovarian sarcoma was caused by a bowel obstruction. Clearly it is the opposite. Also intervals should increase in time as you get farther from the immediate cause of death.

a. Bowel obstruction 2 months
b. Ovarian Sarcoma 7 months

4. Non Reported Trauma

Example 8
In this example, one should question why this individual (who is 38 years old) has decreased his oral intake and what is the etiology of his triparesis. This individual sustained a spinal cord injury as a result of a motor vehicle collision 12 years prior. These types of cases must be reported to the medical examiner's office (1-888-552-2952). The Death Certificate was amended to read:

In this example, one should question why this individual (who is 38 years old) has decreased his oral intake and what is the etiology of his triparesis. This individual sustained a spinal cord injury as a result of a motor vehicle collision 12 years prior. These types of cases must be reported to the medical examiner's office (1-888-552-2952). The Death Certificate was amended to read:

a. Complications of decreased oral intake months
b. Tripalegia 12 years
c. Spinal cord Injury 12 years
d. Blunt impact (motor vehicle collision) 12 years

And the Manner of death was changed to Accident


Example 9
This death also needs to be reported to the OCME. The death certificate would be amended to read:

In this example a pulmonary embolism is listed as the immediate cause (Mechanism) of death with the cause being a hip fracture. The pathophysiology implied is that the immobility during convalescence placed this individual at risk for deep venous thrombosis and pulmonary embolism. What is not listed is the cause of the femoral (hip) fracture.

This 81 year old woman was living independently when she slipped on ice while shoveling snow from her walkway. She was transported to the hospital had surgical fixation and subsequently was discharged to a rehabilitation center. She suffered a sudden collapse while walking. The inclusion of the osteoporosis as a contributory factor is essential. It explains why she is more susceptible to slight trauma.

This death also needs to be reported to the OCME. The death certificate would be amended to read:
a. Pulmonary embolus minutes
b. Thrombosis of Leg veins weeks
c. Immobility weeks
d. Femoral fracture due to blunt impact (Fall) weeks

Contributory: osteoporosis
Manner: Accident (fell from standing height while shoveling snow)


5. Abbreviations

Example 10
Please do not abbreviate. Remember the majority of end users of Death Certificates never went to medical school. Even what we consider common abbreviations have no business on death certificates. Also this cause of death does not make sense. Amyotrophic lateral sclerosis (ALS) usually causes death by a respiratory mechanism.
Please do not abbreviate. Remember the majority of end users of Death Certificates never went to medical school. Even what we consider common abbreviations have no business on death certificates. Also this cause of death does not make sense. Amyotrophic lateral sclerosis (ALS) usually causes death by a respiratory mechanism.

6. Illegibility

Example 11
Although this is a well thought out and written cause of death statement, many people find it difficult if not impossible to read. Please type or print neatly. The purpose is to convey information
Although this is a well thought out and written cause of death statement, many people find it difficult if not impossible to read. Please type or print neatly. The purpose is to convey information

7. Time of Death vs. Pronouncement of death

In this example the physician indicated this patient was not pronounced dead. The pronouncement time is a convention used for medical legal issues. There is no Vermont law requiring a licensed physician to make an official pronouncement of death. By convention (generally accepted agreement) the time of pronouncement is the time when the first "official" person identifies the individual is dead. This should never be left blank.

In this example the physician indicated this patient was not pronounced dead. The pronouncement time is a convention used for medical legal issues. There is no Vermont law requiring a licensed physician to make an official pronouncement of death. By convention (generally accepted agreement) the time of pronouncement is the time when the first "official" person identifies the individual is dead. This should never be left blank.

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