title: Errors in cause-of-death statement on death certificates in intensive care unit of Kathmandu, Nepal.
abstract: BACKGROUND
  Death certificates (DC) are one of the most important medico-legal documents that physicians work through. DCs are extensively used in health statistics for epidemiological studies, and in health policy planning as a public health resource tool. Cause-of-death (COD) statement, which is vulnerable to various errors, is the vital part of a DC that has the potential to mislead the policy makers and statisticians. Hence, we evaluated and analyzed the errors prevalent in COD statement of DC.
  
  
  METHODS
  A retrospective observational study was conducted at medical Intensive Care Unit (ICU) of Blue Cross Hospital, Kathmandu, Nepal within two years of study period. A total of 204 medical records of the deceased patients were reviewed. Three sub-headings of COD statement of DC- Part I Immediate COD (ICOD), Part I Underlying COD (UCOD), and Part II Other significant conditions (OSC) were extensively evaluated for the major medical errors.
  
  
  RESULTS
  The study found errors in 78.4 % of DCs. The highest number of errors was in UCOD (83 %). Most common errors were "Mechanism of Death- terminal event" in ICOD, "More than one competing causes" in UCOD, and "OSC present but not listed" in OSC. The error in DC was found to be statistically significant with the severity of sepsis (p = 0.003), and presence of chronic organ failures (p = 0.034). Age, time of death, source of admission, and duration of ICU stay were not found to be statistically associated with the errors in DC.
  
  
  CONCLUSIONS
  Prevalence of errors in DC was quite high. Most errors were committed in underlying cause of death, which is the most important part of DC. Complexity of the cases was the key factor that increased the risks of committing errors. Specific education should supersede general educational interventions to minimize the errors considerably in writing DC in complex cases.
authors.affiliation: Blue Cross Hospital, Kathmandu, Nepal. leison.maharjan@gmail.com.
authors.forename: Leison
authors.initials: L
authors.lastname: Maharjan
authors.affiliation: Kathmandu Medical College, Kathmandu, Nepal. shahaarzoo@hotmail.com.
authors.forename: Aarzoo
authors.initials: A
authors.lastname: Shah
authors.affiliation: Blue Cross Hospital, Kathmandu, Nepal. khagendra.shrestha@bluecross.com.np.
authors.forename: Khagendra Bahadur
authors.initials: KB
authors.lastname: Shrestha
authors.affiliation: School of Public Health & Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. gambhir.shrestha@bpkihs.edu.
authors.forename: Gambhir
authors.initials: G
authors.lastname: Shrestha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016638:Critical Illness / Q000401:mortality*; D003644:Death Certificates / Q000331:legislation & jurisprudence; D005260:Female; D006291:Health Policy; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D019300:Medical Errors / Q000401:mortality / Q000517:prevention & control / Q000706:statistics & numerical data*; D008499:Medical Records; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011050:Policy Making; D012189:Retrospective Studies; D018805:Sepsis / Q000401:mortality*