Death certification errors in autopsied patients at an academic medical center in the United States

Death certificates are used to tabulate mortality statistics, monitor community health, allocate funds for research, and guide health policy. Autopsy reports can assist certifiers in accurate cause-of-death documentation. This cross-sectional study characterizes death certification errors and assesses autopsy report utilization in death certification. Autopsy reports and death certificates were obtained through the medical records system and local vital records department, respectively from decedents who underwent non-medicolegal autopsies at a large academic medical center from June 2021 to December 2023. A board-certified forensic pathologist compared the cause-of-death statements on death certificates to those in the corresponding hospital autopsy reports. Errors were classified using a standardized four-tier grading scale, with grades three and four representing major errors impacting interpretation of the manner, cause, and/or contributing causes of death. Death certificates were permitted to fulfill multiple grades. 77 death certificates were assessed. Errors were identified in 92% of death certificates, including major errors in 84%. Of all errors documented, 75% were major, including 45% grade 4 errors. In 70% of cases, the underlying cause of death was absent or incorrect. In 49% of cases, major comorbidities/contributing causes of death were absent or incorrect. The manner of death was incorrect in 3% of cases. Only one cause of death was amended; however, the amended cause of death was still incorrect. Overall, we identified a high rate of major death certification errors, which were not correctly amended based on autopsy findings. Correct interpretation and utilization of autopsy reports is essential to improve death certification accuracy.