Concordance between the underlying causes of death on death certificates written by three emergency physicians

OBJECTIVE: This study was conducted to evaluate the concordance between the underlying causes of death (UCOD) on the death certificates written by three emergency physicians (EPs). We investigated errors on the death certificates committed by each EP. METHODS: This study included 106 patients issued a death certificate in the emergency department of an academic hospital. Three EPs reviewed the medical records retrospectively and completed 106 death certificates independently. The selection of the UCOD on the death certificates by each EP (EP-UCOD) was based on the general principle or selection rules. The gold standard UCOD (GS-UCOD) was determined for each patient by unanimous consent between three EPs. We also compared between the EP-UCOD and the GS-UCOD. In addition, we compared between UCODs of three EPs. The errors on the death certificates were investigated by each EP. RESULTS: The rates of concordance between EP-UCOD and the GS-UCOD were 86%, 81%, and 67% for EP-A, EP-B, and EP-C, respectively. The concordance rates between EP-A and EP-B were the highest overall percent agreement (0.783), and those between EP-A and EP-C were the lowest overall percent agreement (0.651). Although each EP had differences in the errors they committed, none of them listed the mode of dying as UCOD. CONCLUSION: This study confirmed that each EP wrote death certificates indicating different causes of death for the same decedents; however, the three EPs made fewer errors on the patients’ death certificates compared with those reported in previous studies.