BackgroundDeath 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.MethodsA 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.ResultsThe 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.ConclusionPrevalence 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.

Background: Multiple organ failure is recognized as the final pathway preceding majority of deaths in intensive care unit. This study aims to find out the prevalence of organ dysfunctions/ failures in patients at the time of their demise irrespective of the underlying diseases in a tertiary care hospital. Methods: This study was done in medical intensive care unit of Blue Cross Hospital. Medical records of all deceased patients in two years period were thoroughly reviewed retrospectively. Status of six organ systems was categorized into five sub-groups: No organ dysfunction, Mild organ dysfunction, Acute organ failure, Acute-on-chronic organ failure, and Chronic organ failure. The proportion of organ dysfunction involved was analyzed along with other variables.Results: Among 204 deaths, majority 165 (80.9%) had Multiple Organ Dysfunction Syndrome. Circulatory system was most affected system with “acute organ failure” 134 (65.5%) followed by acute respiratory failure 128 (62.7%), and acute neurologic failure 114 (55.8%). Neurologic system was most affected with “mild organ dysfunction” 47 (23%) followed by Respiratory system and Renal system. Of the patients who had chronic organ failures at the time of admission, 72 (81.8%) developed “acute-on-chronic failures”.Conclusions: Multiple Organ Dysfunction Syndrome was present in the majority of deaths in critically ill patients. Most common acutely failed organ was the circulatory system.