title: Discrepancies in initial death certificate diagnoses in sudden unexpected out-of-hospital deaths: the role of cardiovascular autopsy.
abstract: BACKGROUND
  The accuracy of death certificates issued for out-of-hospital sudden deaths has been questioned.
  
  
  METHODS
  We retrospectively studied a series of consecutive autopsies performed at two community hospitals.
  
  
  RESULTS
  Fifty-four autopsies in which the deaths were sudden and that occurred outside the hospital were retained for study. The indication for autopsy was largely driven by the wishes of family or physician who was uncertain about the diagnosis. The overall discrepancy rate was 52%. The death certificate diagnosis, rendered before autopsy, was coronary artery disease in 44/54 autopsies (81%). At autopsy, coronary artery disease was the cause of death in 26 cases (48%), cardiomyopathy in 10 (18%), ruptured aneurysm in 8 (15%), pulmonary embolism in 7 (13%), and valve disease in 3 (6%). The diagnosis of coronary artery disease on the death certificate was accurate only 50% of the time. The discrepancy rate was lowest in patients with a history of cardiovascular disease (33%) and was 60% in patients with no prior medical history. The accuracy rate of death certificates was under one third in cases of cardiomyopathy, valve disease, ruptured aneurysm, pulmonary embolism, and valve disease.
  
  
  CONCLUSIONS
  We conclude that in a highly selected group of sudden deaths, in which there was often a question about cause of death, the rate of initial death certificate accuracy is only one half. Furthermore, coronary artery disease as the cause of death is less than 50%, far less than initial death certificate diagnoses would indicate.
authors.affiliation: Department of Pathology, University of Maryland, 22 South Greene Street, Room NBW43, Baltimore, MD 21201, USA. ftavora@gmail.com <ftavora@gmail.com>
authors.forename: Fabio
authors.initials: F
authors.lastname: Tavora
authors.forename: Clinton
authors.initials: C
authors.lastname: Crowder
authors.forename: Robert
authors.initials: R
authors.lastname: Kutys
authors.forename: Allen
authors.initials: A
authors.lastname: Burke
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000401:mortality / Q000473:pathology; D001344:Autopsy; D009202:Cardiomyopathies / Q000401:mortality / Q000473:pathology; D002319:Cardiovascular System / Q000473:pathology*; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology; D003644:Death Certificates; D003645:Death, Sudden / Q000209:etiology*; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies