From the emergency department to vital statistics: cause of death uncertain.

Vital statistics are widely used to evaluate trends in health and illness, inform policy, and allocate resources among health priorities. Literature comparing autopsies to clinical death certification has shown that the clinical "cause of death" certification is inaccurate or incomplete in many cases. Short of increasing autopsies, however, these studies have proposed few improvements. Using the case of death certification in the emergency department (ED), the authors analyzed the current approach to death certification. The authors propose the following to improve the quality of data: 1) acceptance of the declaration "manner of death, natural; cause of death, uncertain"; 2) training for physicians in the selection of appropriate underlying causes of death and "chains of causation"; and 3) participation of physicians with ongoing relationships to the patient in the certification process.