11. Pathology

Office of National Statistics (ONS) cause of death

In the previous NCEPOD report ⁴³, inadequacies in the formulation of the cause of death were highlighted. Pathologists, from their experience, should do this better than most clinicians. But in the available sample of 42 causes of death, 26% (11/42) were defective in the actual structure of the cause of death according to the standard rules, and in a similar proportion the quoted causes of death were judged not congruent with the pathological details in the actual autopsy report.

The following are typical of the problems found:

A. Patient who died following paracetamol overdose.
The stated cause of death was:

1a. bronchopneumonia
1b. intracerebral haemorrhage
1c. hypertension
2.   obesity, enlarged fatty liver.

Better would have been:

1a. bronchopneumonia
1b. liver failure
1c. paracetamol toxicity
2.   hypertension, intracerebral haemorrhage.

B. Patient who died of lung cancer with septic complications. The stated cause of death was:

1a. multifactorial
1b. hepatorenal failure
1c. pyelonephritis
2.   primary lung carcinoma.

Better would have been to place lung carcinoma in the lowest line of part 1 of the cause of death sequence:

1a. multi-organ failure
1b. sepsis
1c. carcinoma of lung.

The Office of National Statistics(ONS) derives data for the main causes of death from the bottom line
of Part 1 in the medical certificate of cause of death. The above cases illustrate how even autopsy diagnoses are not being accurately incorporated into national statistics on cause of death because
of incorrect certification.

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