title: Adverse medical complications: an under-reported contributory cause of death in New York City.
abstract: OBJECTIVE
  The current death certification system in the USA fails to accurately track deaths due to adverse medical events. The aim of this study was to demonstrate the under-reporting of deaths due to adverse medical events due to limitations in the current death certification/reporting system, and the benefits of using the term 'therapeutic complication' as the manner of death.
  
  
  METHODS
  Retrospective review and comparison of death certificates and vital statistical coding.
  
  
  METHODS
  The manner of death is certified as a therapeutic complication when death is caused by predictable complications of appropriate therapy, and would not have occurred but for the medical intervention. Based on medical examiner records, complications that caused or contributed to deaths over a five-year period were examined retrospectively. These fatalities were compared with deaths coded as medical and surgical complications by the New York City Bureau of Vital Statistics.
  
  
  RESULTS
  The Medical Examiner's Office certified 2471 deaths as therapeutic complications and 312 deaths as accidents occurring in healthcare facilities. In contrast, the New York City Bureau of Vital Statistics reported 188 deaths due to complications of medical and surgical care.
  
  
  CONCLUSIONS
  Use of the term 'therapeutic complication' as the manner of death identified nearly 14 times more deaths than were reported by the New York City Bureau of Vital Statistics. If these therapeutic complications and medical accidents were considered as a 'disease', they would rank as the 10th leading cause of death in New York City, surpassing homicides and suicides in some years. Nationwide policy shifts that use the term 'therapeutic complication' would improve the capture and reporting of these deaths, thus allowing better identification of fatal adverse medical events in order to focus on and assess preventative strategies.
authors.affiliation: New York City Office of Chief Medical Examiner, New York, NY, USA; Department of Forensic Medicine, New York University School of Medicine, New York, NY, USA. Electronic address: jgill@ocme.org.
authors.forename: J R
authors.initials: JR
authors.lastname: Gill
authors.affiliation: New York City Office of Chief Medical Examiner, New York, NY, USA; Department of Forensic Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: S F
authors.initials: SF
authors.lastname: Ely
authors.affiliation: New York City Office of Chief Medical Examiner, New York, NY, USA.
authors.forename: A
authors.initials: A
authors.lastname: Toriello
authors.affiliation: Department of Forensic Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Hirsch
mesh_terms: D002423:Cause of Death; D003644:Death Certificates; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007431:Intraoperative Complications / Q000401:mortality*; D008297:Male; D009519:New York City / Q000453:epidemiology; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D014798:Vital Statistics
keywords: Death certification; Fatalities; Medical accidents; Therapeutic complication