A comparative study of the causes of death given in two forensic institutions (Ragama and Edinburgh) and North Colombo Teaching Hospital: lessons we can learn from others

Abstract

INTRODUCTION: Writing the cause of death (COD) according to the WHO format using the International Classification of Diseases has been the accepted practice in order to create comparable national and international statistics. Objective: To analyse whether the forensic doctors and clinicians in the North Colombo Teaching Hospital (NCTH) and the doctors in the Section of Forensic Medicine, University of Edinburgh adhered to WHO proforma and ICD 10 when formulating COD. And to suggest changes if a need was shown by this study. DESIGN, SETTING AND METHODS: CODs written during a six month period in 2003/2004 were obtained from postmortem reports and counterfoils of declaration of death forms from forensic doctors and clinicians respectively. CODs from the Certificates of COD written by forensic doctors in Edinburgh were obtained during a six months period in 2004/2005. RESULTS: 21% of Edinburgh records (n=252) were found to have one or more errors in the COD, whereas CODs written by forensic doctors in NCTH (n=441) had 45% of errors. The main difference between Edinburgh and NCTH was the use of linking words to imply WHO pro-forma by NCTH forensic doctors. Although the clinicians of NCTH use the format of la, Ib, Ic and 2, 79 %( n=432) of CODs had errors. CONCLUSIONS: High error rate of the Sri Lankan sample was due to many reasons. Medical certification of COD according to WHO pro-forma not being a statutory duty, and the COD given by junior doctors without supervision were major reasons.