Certification of cause of death in patients dying soon after proximal femoral fracture

Certification of cause of death has been a legal obligation for medical practitioners since 18741 and has been central to our knowledge of the incidence of fatal diseases. To assess whether certified cause of death reflects the well documented high mortality after fracture of the proximal femur,2 we reviewed the certification of cause of death in patients who died soon after such injuries. If a fracture is mentioned on the death certificate as contributory to death the registrar of deaths has a duty to report it to the coroner and the coroner must hold an inquest. We suspected that the need for an inquest might act as a barrier to doctors recording fractures on the death certificate. We collected data prospectively in 1991-2 …