Title: Accuracy of Medical Certification of Cause of Death: Discrepancies between Clinical and Autopsy Diagnosis

Dr. Alemayehu Shiferaw Lema

St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
MD, Assistant professor of Forensic Medicine and Toxicology, Candidate for MPH in Epidemiology

Keywords: Autopsy, Cause of death, Certification, Certificate, Death certificate, Mortality, Training

ABSTRACT

Postmortem examination is considered the “gold standard” for diagnosing a cause of death, and plays a significant role in
evaluating the quality of health care. The objective of this paper is to evaluate the accuracy of the cause of death as
determined by autopsy in adults who had undergone hospitalization and died from natural cause in 2019 at Saint Paul’s
Hospital and Millennium Medical College. Among cases hospitalized before death, 84 death certificates were collected
and cause of death on the death certificates, compared with the cause of death recorded at autopsy. The overall sensitivity
and positive predictive value of the death certificate for each underlying cause of death, were 0.53 and 0.6 respectively.
The sensitivity of the death certificate in predicting a cause of death by organ system with sensitivities ranging from 0.70
in the neurological system to 0.32 in the cardiovascular system, and the sensitivity for respiratory and gastrointestinal
causes of death was 0.68 and 0.5 respectively. Cardiovascular pathologies were the most common clinically unrecognized
causes of death. There was a significant overall difference (p < 0.001) when comparing causes of death by organ system
on the death certificate with those at autopsy. To implement the most effective health policies and make appropriate
decisions about the allocation of resources, decision‐makers require high‐quality, cause‐specific mortality data on causes
of death. However, there is a significant discrepancy between the diagnosis given on death certificates compared with
autopsy and overall death certificates are inaccurate. Many studies have reported that most problems with the accuracy of
death certificates arise from the limited formal training and perceived lack of certificate importance. An integrated
education program on medical certification of death targeting all three levels of physician; medical students, junior
physicians and senior clinicians, is critical to ensure the generation of high-quality mortality statistics.

Table REFERENCE

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 BIOGRAPHY PRESENTENTING AUTHOR
DETAILS

Dr. Alemayehu is a Medical Doctor,

Assistant professor of Forensic
Medicine and Toxicology, Candidate
for MPH in Epidemiology at St. Paul’s
Hospital Millennium Medical
College, Addis Ababa, Ethiopia. He is
mainly engaged in academics and
research in area of forensic medicine Name/Address: Dr. Alemayehu Shiferaw Lema
and public health. Category: Oral
E-mail address- alemayehu.shiferaw@sphmmc.edu.et

ORCID ID: https://orcid.org/0000-0002-2884-5609