Table 1 Classification matrix of major and minor errors assessed in death certificates

 Multiple causes per line

The WHO ICD guidelines state that only one cause should be recorded per line in a death certificate. When more than one cause is reported on a single line, it makes it difficult for coders to establish the sequence of events leading to death, thus selecting the correct underlying cause of death would be more difficult

 Absence of disease time interval

The time interval should be entered for all conditions reported on the death certificate, especially for the conditions reported in Part 1. Time intervals are very important for correctly coding certain diseases and provide a check on the accuracy of the reported sequence of conditions.

 Incorrect sequence of events leading to death

Mortality statistics are based on the underlying cause of death, which is the condition or injury that initiated the sequence of events that led directly to death. When a clinically improbable sequence of events is recorded, it is impossible to select the correct underlying cause of death.

 Ill-defined or poorly specified condition entered as the UCOD

Ill-defined or poorly specified conditions are of no value for public health officials, and do not provide any information for decision-makers to help them design preventive health programs.

These include, for example, organ failure (hepatic or cardiac failure, etc.); symptoms or signs (hematemesis, dyspnoea, fever, etc.); mode of dying (cardiac arrest, respiratory arrest); pathophysiological findings (shock); other (trivial diseases such as colds, rhinitis, etc.).

 Presence of blank spaces within the sequence of events

In completing a death certificate the certifier should use consecutive lines in Part 1 of the death certificate starting at Line 1a. The UCOD should be recorded in the lowest used line of Part 1. There should not be any blank lines within the sequence/chain of events leading to death.

 Abbreviations used in certifying the death

Doctors are encouraged not to use abbreviations when certifying deaths as abbreviations can mean different things to different people. There is a chance that coders may misinterpret the abbreviation and code the death to a non-relevant code.

 Additional errors on the certificate

There may be other additional errors on death certificates including: incomplete information of the external cause of death (no site of the injury, intent or nature of it, etc.); insufficient information on neoplasms (no site, whether benign or malignant, etc.); failing to identify pregnancy and maternal deaths.