External causes
Injuries
Injuries should never be reported on the Medical Certificate of Cause of Death (MCCD) without the circumstances that led to the injury. In most instances, deaths occurring as the result of an accident must by law be referred to the coroner. When a medical practitioner has occasion to issue a MCCD relating to a death resulting from an accident, the circumstances of the accident as well as the injuries incurred need to be reported. For example, 'fractured skull with cerebral haemorrhage due to accidental fall on stairs at home' or 'fractured neck of femur due to fall from bed in nursing home'.
When certifying deaths due to external causes:
- Include all injuries sustained and avoid using non-specific terms such as 'multiple injuries'.
- If a death is due to late effects of a previous injury, state the circumstances of this injury, e.g. bronchopneumonia due to paraplegia due to motor vehicle accident 3 years ago.
- Always certify the reason for the injury (the mechanism of death).
- Check guidelines for referring a death to the coroner as most deaths due to external causes are reportable deaths in Australia.
The following example shows how a death due to an external cause may be certified. The manner (accident) and mechanism (trip on carpet) are clearly stated, as well as the resulting injury and associated complications. Risk factors which increased the propensity to fall and severity of the injury are also included in Part 2 of the certificate.
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Description
Example of a completed Medical Certificate of Cause of Death. The certificate contains 6 lines for completion separated into two parts. Part 1, line A for the disease or condition leading directly to death. Part 1 lines B, C, D and E for antecedent causes which are morbid conditions, if any, giving rise to the above cause, stating the underlying condition last. Part 2 of the certificate is a single line for other significant conditions contributing to the death but not directly related to the disease or condition causing it. For both Part 1 and Part 2 there is a column to record the approximate interval between onset and death for the conditions on each line.
The certificate is filled out as follows:
- Part 1(a): Klebsiella pneumonia. Approximate interval between onset and death: 2 days
- Part 1(b): Internal fixation for fracture repair. Approximate interval between onset and death: 3 weeks
- Part 1(c): Traumatic neck of femur fracture. Approximate interval between onset and death: 3 weeks
- Part 1(d): Trip on carpet edge at home. Approximate interval between onset and death: 3 weeks
- Part 1(e): Blank
- Part 2: Frailty, osteoporosis, macular degeneration, osteoarthritis. Approximate interval between onset and death: 3 years, 20 years, 10 years, 10 years