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Medical education and training
Research
Improper cause-of-death statements by specialty of certifying physician: a cross-sectional study in two medical centres in Taiwan
  1. Tain-Junn Cheng1,2,
  2. Fang-Chuan Lee3,
  3. Shio-Jean Lin4,
  4. Tsung-Hsueh Lu3
  1. 1Department of Medical Record and Information Management, Occupational Medicine and Neurology, Chi Mei Medical Center, Tainan, Taiwan
  2. 2Department of Occupational Safety, College of Environment, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
  3. 3NCKU Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  4. 4Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan
  1. Correspondence to Dr Tsung-Hsueh Lu; robertlu{at}mail.ncku.edu.tw

Abstract

Objective To determine the frequency of various types of improper cause-of-death (COD) statements reported on death certificates and whether the frequency differed by specialty of the certifying physician.

Design Cross-sectional descriptive study.

Setting 2 medical centres in Tainan, Taiwan.

Participants A total of 2520 death certificates issued by 230 physicians.

Main outcome measures 4 types of improper COD statements based on the criteria of correctness of the COD causal sequence and the level of specificity of underlying COD selected.

Results Of 2520 death certificates analysed, 502 (19.9%) had at least one type of improper COD statement. However, only 235 (9.3%) sustained major errors, that is, 91 (3.6%) reported incorrect causal sequence and 144 (5.7%) reported only mechanism(s) of death (such as respiratory failure, heart failure, sepsis and acidosis). The improper reporting rate was highest among nephrologists (53%, 24/45), followed by infectious diseases physicians (45%, 29/65) and was lowest among oncologists (6%, 57/995).

Conclusions About one-fifth issued death certificates sustained improper COD statements and only one-tenth had noteworthy errors that would threaten the quality of COD statistics. The frequency varied by specialty of the certifying physician because physicians in different specialties manage different types of diseases and conditions with contrasting complexities in terms of determining the causal sequence and specificity of COD statements.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

https://doi.org/10.1136/bmjopen-2012-001229

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    Footnotes

    • To cite: Cheng T-J, Lee F-C, Lin S-J, et al. Improper cause-of-death statements by specialty of certifying physician: a cross-sectional study in two medical centres in Taiwan. BMJ Open 2012;2:e001229. doi:10.1136/bmjopen-2012-001229

    • Contributors T-JC, F-CL and T-HL researched the data and wrote the manuscript. S-JL reviewed/edited the manuscript and contributed to the discussion.

    • Funding This work was funded by the Chi-Mei and National Cheng Kung University Joint Program (CMNCKU9916). The funding sources had no role in the design and conduct of the study; the collection, management, analysis and interpretation of the data or the preparation, review and approval of the manuscript.

    • Competing interests None.

    • Ethics approval This study was approved by the Institution Review Boards of Chi-Mei Medical Center (09909-004) and the National Cheng Kung University Hospital (ER-99-170).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.