Death certificate accuracy in a Tunisian Emergency Department

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Published Dec 27, 2017
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Vol. 95 No. 6 (2017): Issue Jun 2017

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Mehdi Ben Khelil
Majed Kamel
Sana Lahmar
Ali Mrabet
Nabiha Borsali Falfoul
Moncef Hamdoun

Abstract

Objective: Assess Death Certificates accuracy (DCs) issued by a teaching emergency department in Tunis.
Methods: It is a descriptive study. We included all death certificates issued in the Emergency Department of a teaching Hospital in Tunis over 17 months period (October 2013 - March 2014). Twenty-one errors have been predefined and classified as “Editing errors” or “Medical analysis error” then as major or minor errors.
Results: 757 certificates were studied; all DCs had at least three errors with an average number of errors of 6.92±1.55.      The mechanism of death was inadequate in 20% of the DCs.  The cause of death was “unacceptable” in 21% of the DCs.
Conclusion: The results are similar to those reported in international literature. Therefore, it is urgent to start working on further and regular training on how to fulfil a death certificate for undergraduate and postgraduate medical students.

Keywords:

Death certificate, Accuracy, Mortality, Epidemiology, Public health

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References

  1. Mathers CD, Fat DM, Inoue M, Rao C, Lopez AD. Counting the dead and what they died from: an assessment of the global status of cause of death data. Bull World Health Organ 2005;83(3):171-7.
  2. Haque AS, Shamim K, Siddiqui NH, Irfan M, Khan JA. Death certificate completion skills of hospital physicians in a developing country. BMC Health Serv Res 2013;13:205.
  3. Villar J, Pérez-Méndez L. Evaluating an educational intervention to improve the accuracy of death certification among trainees from various specialties. BMC Health Serv Res 2007;7:183.
  4. RECOMMENDATION No. R (99) 3 on the harmonisation of medico-legal autopsy rules. Forensic Sci Int 2000. doi: http://dx.doi.org/10.1016/S0379-0738(00)00186-9.
  5. Jordan JM, Bass MJ. Errors in death certificate completion in a teaching hospital. Clin Invest Med 1993;16(4):249-55.
  6. Slater DN. Certifying the cause of death: an audit of wording inaccuracies. J Clin Pathol 1993;46(3):232-4.
  7. Myers KA, Farquhar D. Improving the accuracy of death certification. CMAJ 1998;158(10):1317-23.
  8. Armour A, Bharucha H. Nosological Inaccuracies in death certification in Northern Ireland. A comparative study between hospital doctors and general practitioners. Ulster Med J 1997;66(1):13-7.
  9. Peach HG, Brumley DJ. Death certification by doctors in non-metropolitan Victoria. Aust Fam Physician 1998;27(3):178-82.
  10. Hajem s, Hsairi pm. Le systeme national d'information sur les causes de deces: diagnostic de situation et principaux resultats. Available at: http://193.95.84.5/surven_tunisie/images/publ_non_index/Hsairi1.pdf.
  11. Alaya NB Ben, Hajem S, Ennigrou S, Touati M, Hamida A Ben, Zouari B. [Certification of cause of death in Tunisia]. Tunis Med 2000;78(12):713-8.
  12. Niska R, Bhuiya F, Xu J. National hospital ambulatory medical care survey: 2007 emergency department summary. Natl Health Stat Report 2010;(26):1-31.
  13. Burger EH, Merwe L, Volmink J. Errors in the completion of the death notification form. S Afr Med J 2007;97(11):1077-81.
  14. Lu TH, Shau WY, Shih TP, Lee MC, Chou MC. Factors associated with errors in death certificate completion: a national study in Taiwan. J Clin Epidemiol 2001;54(3):232-8.
  15. Katsakiori PF, Panagiotopoulou EC, Sakellaropoulos GC, Papazafiropoulou A, Kardara M. Errors in death certificates in a rural area of Greece. Rural Remote Health 2007;7(4):822.
  16. U.S. Department of Health and Human Services, Center for Disease Control and Prevention. Physicians' Handbook on Medical Certification of Death. National Center for Health Statistics, April 2003. Available at: http://www.cdc.gov/nchs/data/misc/hb_cod.pdf.
  17. U.S. Departement of Health and Human Services, Center for Disease Control and Prevention. Instruction Manual. Part 20. ICD-10 cause of death querying 2010. National Center for Health Statistics, December 2009. Available at: http://www.cdc.gov/nchs/data/dvs/20_Instruction_Manual_2010.pdf.
  18. Office for National Statistics' Death Certification Advisory Group. Guidance for doctors completing medical certificates of cause of death in England and Wales. Office for National Statistics, July 2010. Available at: http://www.gro.gov.uk/images/medcert_july_2010.pdf.
  19. Office of the Registrar General. Handbook on medical certification of death. Ministry of Consumer and Business Services, August 2010 Available at: http://www.publications.serviceontario.ca/ecomlinks/016600.pdf.
  20. Swain GR, Ward GK, Hartlaub PP. Death certificates: let's get it right. Am Fam Physician 2005;71(4):652, 655-6.
  21. Cheng TJ, Lee FC, Lin SJ, Lu TH. Improper cause-of-death statements by specialty of certifying physician: a cross-sectional study in two medical centres in Taiwan. BMJ Open 2012;2(4).
  22. Agarwal SS, Kumar V, Kumar L, Bastia BK, Chavali KH. A study on appraisal of effectiveness of the MCCD scheme. J Indian Acad Forensic Med 2010;32(4):318-320.
  23. Pritt BS, Hardin NJ, Richmond JA, Shapiro SL. Death certification errors at an academic institution. Arch Pathol Lab Med 2005;129(11):1476-9.
  24. Patel AB, Rathod H, Rana H, Patel V. Assessment of medical certificate of cause of death at a new teaching hospital in Vadodara. Endocrine 2011;3:7.5.
  25. Nojilana B, Groenewald P, Bradshaw D, Reagon G. Quality of cause of death certification at an academic hospital in Cape Town, South Africa. S Afr Med J 2009;99(9):648-52.
  26. Sibai AM, Nuwayhid I, Beydoun M, Chaaya M. Inadequacies of death certification in Beirut: who is responsible? Bull World Health Organ 2002;80(7):555-61.
  27. Manaouil C, Montpellier D. [Some practical questions for death certification]. Ann Fr Anesth Reanim 2008;27(2):186-9.
  28. Nour EA, Mohammed A, Yousif I, Ali AH. Evaluation of death certificates in the pediatric hospitals in Khartoum state during 2004. Sudan J Public Health 2007;2(1):29-37. Available at: http://www.sjph.net.sd/files/vol2i1p29-37.pdf.
  29. Stark MM. Literature review of death certification procedures--international aspects. J Clin Forensic Med 2003;10(1):21-6. doi:10.1016/S1353-1131(02)00165-7.
  30. Hanzlick R. Cause-of-Death Statements and Certification of Natural and Unnatural Deaths. Northfield, III: College of American Pathologists; 1997..
  31. Pattaraarchachai J, Rao C, Polprasert W, et al. Cause-specific mortality patterns among hospital deaths in Thailand: validating routine death certification. Popul Health Metr 2010;8:12. doi:10.1186/1478-7954-8-12.
  32. Vial-Reyt K, Vallee J. Certification de décès et médecins généralistes: opinions sur les propositions d'amélioration Enquête qualitative réalisée auprès de 14 médecins généralistes de la Loire. Rev Prat 2011;61(10):1401-10.
  33. Maudsley G, Williams E. “Inaccuracy”in death certification-where are we now? J Public Health Med 1996;18(1):59-66.
  34. Comstock GW, Markush RE. Further comments on problems in death certification. Am J Epidemio. 1986;124(2):180-1.
  35. Walker S, Rampatige R, Wainiqolo I. An accessible method for teaching doctors about death certification. HIM J 2012;41(1):4-10.
  36. Weeramanthri T, Beresford W, Sathianathan V. An evaluation of an educational intervention to improve death certification practice. Australian clinical review/Australian Medical Association [and] the Australian Council on Hospital Standards 1992;13(4):185-189.
  37. Ali N, Hamadeh RR. Improving the Accuracy of Death Certification among Secondary Care Physicians. Bahrain Med Bull 2013;35(2):56. Available at: http://www.bahrainmedicalbulletin.com/june_2013/Improving_Accuracy.pdf.
  38. Lakkireddy D, Basarakodu K, Vacek J, et al. Improving Death Certificate Completion: A Trial of Two Training Interventions. J Gen Intern Med 2007;22(4):544-8.