Table 1 Classification of major and minor errors on medical certificates of cause of death

 Multiple causes per line

The WHO ICD guidelines state that only one cause should be recorded per line in a medical certificate of cause of death (MCCOD). When more than one cause is reported on a single line, there will be more than one potential sequence, making it difficult for coders to identify the correct sequence of events leading to death, thus making it more difficult to select the correct underlying cause of death (UCOD).

 Incorrect sequence of events leading to death

Mortality statistics are based on the UCOD, which is the condition or injury that initiated the sequence of events that led directly to death. When a clinically improbable sequence of events is recorded, it is impossible to select the correct UCOD.

 Illegible handwriting

Illegible handwriting makes it difficult to determine if the sequence of events leading to death is probable or if an ill-defined condition is entered as an underlying cause. Illegible handwriting can also prevent coders from selecting the UCOD, rendering the MCCOD unusable for statistical purposes.

 Ill-defined or poorly specified condition entered as the underlying COD

Ill-defined or poorly specified conditions are of no value for public health priority setting and do not provide any information for decision-makers about the comparative need for specific diseases and injury prevention programmes.

These include, for example, organ failure (e.g. hepatic or cardiac failure), symptoms or signs (e.g. hematemesis, dyspnoea, fever), mode of dying (e.g. cardiac arrest, respiratory arrest), pathophysiological findings (shock), and others (trivial diseases such as colds, rhinitis).

 Insufficient information on the external COD

Sufficient detail should be provided to identify the UCOD (e.g. circumstances, intent or nature of the accident or violence).

 Insufficient information on neoplasms

Sufficient detail should be provided regarding the neoplasm (e.g. site, whether benign or malignant).

 Presence of blank spaces within the sequence of events

In completing the MCCOD, the certifier should use consecutive lines in part 1 of the certificate starting at line 1a. The UCOD should be recorded in the lowest used line of part 1. There should not be any blank lines within the sequence/chain of events leading to death.

 Abbreviations used in certifying the death

Doctors are encouraged not to use abbreviations when certifying deaths as abbreviations can mean different things to different people. There is a chance that coders may misinterpret the abbreviation and code the death to a non-relevant cause.

 Absence of disease time interval

The time interval should be entered for all conditions reported on the MCCOD, especially for the conditions reported in part 1. Time intervals are very important for correctly coding certain diseases and provide a check on the accuracy of the reported sequence of conditions.

 Additional errors on the certificate

There may be other additional errors on MCCODs failing to identify pregnancy and maternal deaths.