Accuracy of cause of death in hospital death declaration forms.

Death declaration forms are legal records of death, necessary for burial or cremation of the dead and for medico-legal procedures concerning insurance and inher­ itance. As the forms include a section dealing with "cause of death", they can be used for compiling mortality statis­ tics in medical research and health policy planning. In the section dealing with "cause of death" doctors are expected to certify (a) the immediate cause (b) antecedent and/or underlying causes and (c) contributory causes of death. We sought to determine whether the causes of death docu­ mented in death declaration forms issued at the Lady Ridgeway Hospital (LRH) accurately reflect the disease responsible for death. Case notes of 128 children who died at LRH during a S-month period commencing from May 2000 were analysed to identify the disease responsible for death. The counter­ foils of the corresponding death declaration forms were reviewed to determine whether this disease was accurately documented. The cases were divided into 7 categories as shown in the table. At present at the LRH, mortality statistics are com­ plied by non-medical personnel, who scrutinise the case notes for the cause of death. This procedure is cumber­ some and liable to error. It would be simpler to use the cause of death documented in the counterfoil of accu­ rately certified death declaration forms. However, the results of this study show that the " cause of death" has not been accurately certified in 91.4% of these forms. A study at the General Hospital Colombo in 1986, showed that 38% of death certificates were accurately, recorded (1), although this study analysed only the format of re­ cording of death declaration forms and case notes were not scrutinised to determine if the cause of death was accurately reflected. The category "immediate cause of death" should not include modes of death such as cardio-respiratory arrest, asphyxia or coma (2). The certification of cardio-respira­ tory arrest as the immediate cause in 70% of cases in the present study shows that this is poorly understood. Pulmonary heart disease including disease of pulmonary circulation is listed as the fourth leading cause of hospital deaths in Sri Lanka (3). It is possible that some cases of cardio-respiratory arrest have been included this category. As in the British death declaration forms (2), Sri Lankan forms should include instructions not to include modes of death as causes. In the present study in 61.7% of …