Evidence for cause of death in patients dying in an accident and emergency department

Objective: This study assesses the evidence used for certification of the cause of death in an accident and emergency department. Methods: The subjects were all patients for whom a certificate of the cause of death was issued in the A&E department of a Scottish district general hospital over a period of two years from September 1998 to August 2000. The case notes and details of necropsies were examined for evidence of the cause of death. Patients were allocated to one of three descending categories according to the strength of the evidence available; (1) Evidence of the cause of death was available at the time of death or from postmortem examination. (2) There was a history (hospital notes/from relatives/from GP) of morbidity supporting the cause. (3) There was no recorded history of morbidity supporting the stated cause of death. Results: There were a total of 28 deaths in the A&E department over the study period. Two of the patients who died in A&E received postmortem examinations and had death certificates completed by pathologists. Death certificates were issued from A&E for a total of 24 cases. Of these 24, nine patients had strong evidence of the given cause of death and eight patients had a past history or other identifiable evidence that could support the cause of death. The cause of death in seven patients was not directly supported by available evidence. Conclusion: Death certificates issued in an A&E department were supported by strong evidence in one third of cases. Many certificates seem to be issued with slender evidence for the cause of death readily identifiable, and few patients are subjected to necropsy.