Examples of incorrect and correct cause of death certification

On this page:

Part 2

Incorrect:  
Part 1  
 (a) Cardiac Arrest 1 hour
 (b) Cardiogenic shock 3 hours
 (c) Lactic acidosis 3 hours
Part 2  
Coma (3 hours)
Insulin-dependent type 2 diabetes mellitus

Explanation: The problem in the above table is the Type 2 diabetes mellitus was the underlying cause of the lactic acidosis, cardiogenic shock and cardiac arrest so it should be entered in Part 1 (c) as the underlying cause of death. Cardiac arrest was the mode of death so should be omitted.

Correct:  
Part 1  
 (a) Cardiogenic shock 1 hour
 (b) Lactic acidosis and coma 3 hours
 (c) Insulin-dependent type 2 diabetes mellitus years
Part 2  
-

Mode of dying and Part 2

Example 1:

Incorrect:  
Part 1  
 (a) Respiratory failure   7 days
 (b) Left-sided pneumonia 9 days
 (c) - -
Part 2  
Systemic lupus erythematosus (6 years)
Immunosuppression, hypertension (years)

Explanation: The problem in the above table is that systemic lupus erythematosus with immunosuppression was the underlying cause of death so should be entered in Part 1 (c). Respiratory failure was the mode of death so should be omitted

Correct:  
Part 1  
 (a) Left-sided pneumonia 9 days
 (b) Immunosuppression due to corticosteroids years
 (c) Systemic lupus erythematosus 6 years
Part 2  
Hypertension (years)

Example 2:

Incorrect:  
Part 1  
 (a) Cardiac Arrest minutes
 (b) Cachexia 2 weeks
 (c) Metastatic poorly differentiated carcinoma months
Part 2  
Malignant ascites (months)
Ulcerative colitis (42 years)
Carcinoma cervix (25 years)

Explanation: The problem here is the primary site of the carcinoma, carcinoma of the cervix, was the underlying cause of the metastatic poorly differentiated carcinoma so should be entered as the underlying cause of death in Part 1. Cardiac arrest was the mode of death so should be omitted.

Correct:  
Part 1  
 (a) Cachexia 2 weeks
 (b) Metastatic poorly differentiated carcinoma, malignant ascites months
 (c) Carcinoma cervix 25 years
Part 2  
Ulcerative colitis (42 years)

Accidents and injuries in the elderly

Incorrect:  
Part 1  
 (a) Pneumonia 2 weeks
 (b) Immobility 6 weeks
 (c) Fractured neck of left femur 6 weeks
Part 2  

Explanation: The problem in the above table is the accident that caused the fractured neck of the femur is the underlying cause of death so needs to be entered below the fractured neck of the femur in Part 1.

Correct:  
Part 1  
 (a) Pneumonia due to immobility 6 weeks
 (b) Fractured neck of left femur       6 weeks
 (c) Slipped and fell on bathroom floor at home 6 weeks
Part 2  

 Atherosclerosis – specificity

Incorrect:  
Part 1  
 (a) Congestive heart failure 4 days
 (b) Atherosclerosis 20 years
 (c)  
Part 2  
Cerebrovascular accident (2 years)

Explanation: The problem here is atherosclerosis can affect different organs in the body so more information needs to be entered in Part 1 to indicate the organ affected. This allows more specific classification of the underlying cause of death

Correct:  
Part 1  
 (a) Congestive cardiac failure 4 days
 (b) Ischaemic heart disease 20 years
 (c) Atherosclerosis 20+ years
Part 2  
Cerebrovascular accident (2 years)

 Cancer – exact site of primary cancer 

Incorrect:  
Part 1  
 (a) Septicaemia                7 days
 (b) Disseminated malignancy 2 years
 (c) Bowel cancer 4 years
Part 2  

Explanation: The problem here is that ‘Bowel cancer’ is not specific enough (unless the exact primary site within the bowel is unknown). Specify the site within the bowel.

Correct:  
Part 1  
 (a) Septicaemia 7 days
 (b) Disseminated malignancy 2 years
 (c) Cancer of sigmoid colon 4 years
Part 2  

Metastases – site of primary cancer

Incorrect:  
Part 1  
 (a) Metastatic adenocarcinoma of bones 3 months
 (b)  
 (c)  
Part 2  
Aspiration pneumonia 7 days

Explanation: The problem here is the primary site of the cancer is not stated. Aspiration pneumonia is the direct cause of death so should be entered in Part 1 (a).

Correct:  
Part 1  
 (a) Aspiration pneumonia 7 days
 (b) Metastatic adenocarcinoma of bones 3 months
 (c) Adenocarcinoma prostate 2 years
Part 2  

 Qualify 'neoplasm or tumour' 

Incorrect:  
Part 1  
 (a) Cerebral neoplasm          several months
 (b)  
 (c)  
Part 2  

Explanation: The problem here is the type of cerebral neoplasm is unstated. The person classifying the cause of death cannot tell if the cerebral neoplasm was malignant or benign, and if it was malignant, whether it was a primary or secondary cancer.

Correct:  
Part 1  
 (a) Astrocytoma cerebellum              several months
 (b)  
 (c)  
Part 2  

Note: Astrocytoma is considered to be a primary cancer of the brain, (unless specified otherwise), therefore entering Astrocytoma cerebellum in Part 1 (a) provides all the information that is required to accurately describe the underlying cause of death.

Cardiac arrhythmias 

Incorrect :  
Part 1  
 (a) Chronic heart failure -
 (b)  
 (c)  
Part 2  
Atrial fibrillation

Explanation: The problem here is that cardiac arrhythmias are often caused by other known heart disease. Where this is the case the underlying heart disease should be entered as the cause of the arrhythmia.

Correct:  
Part 1  
 (a) Chronic heart failure months
 (b) Atrial fibrillation 1 year
 (c) Coronary atherosclerosis years
Part 2  

Gastrointestinal haemorrhage

Incorrect:  
Part 1  
 (a)  Gastrointestinal haemorrhage 2 weeks
 (b)  
 (c)  
Part 2  

Explanation: The problem here is the cause of the gastrointestinal haemorrhage (the direct cause of death) is not stated.

Correct:  
Part 1  
 (a) Gastrointestinal haemorrhage    2 weeks
 (b) Prolonged use non-steroidal anti-inflammatory drugs 16 years
 (c) Rheumatoid arthritis multiple sites 16 years
Part 2  

Operation

Incorrect:  
Part 1  
 (a) Bronchopneumonia 2 days
 (b) Post-op hernia repair 4 days
 (c)  
Part 2  

Explanation: The problem here is that, whilst it is important to know the deceased had surgery in the days or month prior to death, the condition for which the surgery was required is classified as the underlying cause of death. Therefore details about that condition need to be included in Part 1 (c).

Correct:  
Part 1  
 (a) Bronchopneumonia        2 days  
 (b) Post-op hernia repair 4 days  
 (c) Strangulated left inguinal hernia 5 days  
Part 2  

 Pneumonia 

Incorrect:  
Part 1  
 (a) Pneumonia         2 weeks
 (b) Immobilisation 12 months
 (c)  
Part 2  

Explanation: The problem here is the condition causing immobilisation has not been documented. That condition will be the underlying cause of death.

Correct:  
Part 1  
 (a) Pneumonia 2 weeks
 (b) Immobilisation 12 months
 (c) Multiple Sclerosis 25 years
Part 2  

Pulmonary embolism

Incorrect:  
Part 1  
 (a) Pulmonary embolus       immediate
 (b) Immobility 6 months
 (c)  
Part 2  
Chronic bronchitis and emphysema (6 years)  

Explanation: The problem here is that pulmonary embolism often results from a deep vein thrombosis that has developed due to immobility caused by another condition. The condition resulting in immobility should be entered as the underlying cause of death.

Correct:  
Part 1  
 (a) Pulmonary embolus       immediate
 (b) Deep vein thrombosis due to immobility 3 days
 (c) Chronic bronchitis and emphysema 6 years
Part 2  
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