What is the proper procedure for completing a death certificate when the cause of death is unknown?

From the Guidelines

When filling out a death certificate without knowing the cause of death, you should indicate "undetermined" in the cause of death section until proper investigation can be completed, as relying on death certificates alone may be problematic due to inaccurate coding 1. This approach prioritizes the accuracy of death certification, which is crucial for public health statistics, legal matters, and family closure. Key considerations in this situation include:

• Consulting with the medical examiner or coroner in your jurisdiction immediately to follow proper protocols for handling uncertain cases
• Ordering an autopsy to assess the cause of death, as autopsy reports are often valuable in such cases 1
• Referring the case to the medical examiner's office if necessary
• Avoiding speculation or guessing about the cause of death, as falsifying information on a death certificate is illegal and unethical
• Following institutional protocols and guidelines for death certification, such as those outlined for specific scenarios like the death of a child in the emergency department 1
• Ensuring that the death certificate is completed accurately and thoroughly, with attention to details like the location of death and the primary cause of death, if known 1.

From the Research

Filling Out a Death Certificate with Unknown Cause of Death

• When filling out a death certificate and the cause of death is unknown, the certifier may list the cause of death as unknown or undetermined, which is perfectly acceptable in certain circumstances 2.
• In cases where death was not anticipated and a thorough postmortem examination fails to establish a cause of death, listing the cause of death as unknown is a viable option 2.
• Alternatively, the certifier may choose what they feel would be the most likely cause of death given the statistical likelihood of causes of death in individuals similar to the decedent 2.
• The World Health Organisation recommends avoiding the use of ill-defined and unknown causes of death in the death certificate, as this terminology does not provide any information concerning the possible conditions that led to the death 3.

Investigating the Cause of Death

• Forensic autopsy can be an effective method for investigating the cause of death, especially in cases where the cause is unknown 3, 4.
• In Finland, all deaths with unknown cause are investigated with a forensic autopsy, resulting in a lower frequency of ill-defined and unknown causes of death 3.
• The use of post-mortem imaging modalities, such as post-mortem computed tomography (PMCT) and post-mortem computed tomography angiography (PMCTA), can also provide incremental benefits in diagnosing the cause of death 4.

Coding and Classification of Unknown Cause of Death

• The International Classification of Diseases (ICD) codes R00-R99 are used for "symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified" and are designated as "ill-defined" or "with unknown etiology" 3.
• The coding and classification of unknown cause of death can vary between countries, with some countries having a higher frequency of ill-defined and unknown causes of death than others 3.
• The use of written text on death certificates can provide additional information for differentiating cause-of-death terminology for deaths coded as sudden infant death syndrome, accidental suffocation, and unknown cause 5.