Death Certificate Inaccuracy and Underreporting of Injury in Elderly People


Address correspondence to Marian E. Betz, MD, MPH, Beth Israel Deaconess Medical Center, One Deaconess Road WCC-2, Boston, MA 02215. E-mail:


OBJECTIVES: To assess whether resident physicians (MDs) could complete a death certificate for elderly patients with injury-related fatalities and whether their abilities were related to training or other factors.

SETTING: A large tertiary teaching hospital in Boston, Massachusetts.

PARTICIPANTS: Three hundred thirty-six MDs.

DESIGN: Through an anonymous Web-based test, MDs were questioned regarding prior training and experience in completion of death certificates. The MDs read a case of an elderly patient who died from intracranial bleeding after a fall and then completed a test death certificate. Whether proper completion was associated with MD characteristics such as year of residency, self-assessment, or previous death certificate experience was examined.

RESULTS: Almost two-thirds (63.6%) of MDs completed the test. Of participants, 52% (95% confidence interval (CI)=46–59%) filled out the death certificate with the correct primary cause of death and 10% (95% CI=6–14%) listed the three major contributing causes of death. Only 35% (95% CI=28–41%) correctly reported injury as a contributing cause of death, but 51% of the participants reported a high level of confidence in their ability to complete a death certificate accurately.

CONCLUSION: Accurate completion of the sample death certificate and identification of injury was low, and MDs overrated their abilities. Death certificates completed by MDs may not be accurate and may underestimate the contribution of injury to elderly mortality.