Medical Students’ Knowledge of the Cause-of-Death Certification: A Descriptive, Cross-Sectional Study from Saudi Arabia

Figures & data

Table 1 Case Scenario and the Correct Cause-of-Death Statement

Cause-of-Death Statement
Cause of Death		Approximate Interval Between Onset and Death
I. Disease or condition directly leading to death Antecedent causes (morbid conditions, if any, giving rise to the above cause)	(a)Pulmonary embolism	5 hours
	(b) Deep vein thrombosis of the right leg (c) Factor V Leiden thrombophilia (d) ____________________ (e) ___________________	10 days 5 years _________ _________
II. Other significant conditions contributing to the death	Bronchial asthma _____________	15 years _________

Notes: Noorah, aged 29, presented to the emergency department of a hospital with severe breathlessness of 4 hours duration. Ten days prior to her presentation to the emergency department, she had suffered from pain and swelling of the calf region of the right lower limb and a diagnosis of deep vein thrombosis (DVT) of the right leg was made by her family physician. Other significant past history revealed that she was diagnosed with factor V Leiden thrombophilia in 2015. She is a known asthmatic for the last 15 years. One hour after her present admission to the hospital, she suffered a cardiac arrest and was pronounced dead after a failed resuscitation effort.

Table 2 Students’ Knowledge and Practice in Completing the Cause-of-Death Statement

Cause of Death and Approximate Interval Between Onset and Death	Correct Answer	Wrong Answer
I (a): Disease or condition directly leading to death	107 (61.5%)	67 (38.5%)
Approximate interval between onset of I (a) and death	99 (56.9%)	75 (43.1%)
I (b): Antecedent cause [morbid condition, if any, giving rise to the above cause, that is I (a)]	124 (71.3%)	50 (28.7%)
Approximate interval between onset of I (b) and death	118 (67.8%)	56 (32.2%)
I (c): Antecedent cause [morbid condition, if any, giving rise to the above cause, that is I (b)]	20 (11.5%)	154 (88.5%)
Approximate interval between onset of I (c) and death	18 (10.3%)	156 (89.7%)
I (d): Antecedent cause [morbid condition, if any, giving rise to the above cause, that is I (c)]	167 (96%)	7 (4%)
Approximate interval between onset of I (d) and death	167 (96%)	7 (4%)
II: Other significant conditions contributing to death	151 (86.8%)	23 (13.2%)
Approximate interval between onset of II and death	140 (80.5%)	34 (19.5%)

Table 3 Students Responses to 10 Independent Statements/Questions on the Cause-of-Death Certification

The Statement	Agree	Disagree	I Do Not Know^#	The Correct Answer
1. A physiotherapist/physical therapist involved in the care of the patient during his/her final illness is entitled to fill the cause-of-death section of the death certificate/death notification form. Do you agree with this statement?	32 (18.3%)	111 (63.9%)	31 (17.8%)	Disagree
2. A pharmacist involved in the care of the patient during his/her final illness is entitled to fill the cause-of-death section of the death certificate/death notification form. Do you agree with this statement?	13 (7.5%)	117 (67.2%)	44 (25.3%)	Disagree
3. A nurse involved in the care of the patient during his/her final illness is entitled to fill the cause-of-death section of the death certificate/death notification form. Do you agree with this statement?	37 (21.2%)	99 (56.9%)	38 (21.9%)	Disagree
4. A doctor involved in the care of the patient during his/her final illness is entitled to fill the cause-of-death section of the death certificate/death notification form. Do you agree with this statement?	139 (79.9%)	2 (1.1%)	33 (19%)	Agree
5. Cardiorespiratory arrest can be considered as an appropriate option for the immediate cause of death. Do you agree with this statement?	30 (17.2%)	115 (66.1%)	29 (16.7%)	Disagree
6. Asphyxia can be considered as an appropriate option for the underlying cause of death. Do you agree with this statement?	30 (17.2%)	119 (68.4%)	25 (14.4%)	Disagree
7. The immediate cause of death can be considered to be the underlying cause of death in certain cases. Do you agree with this statement?	102 (58.6%)	21 (12.1%)	51 (29.3%)	Agree
8. The underlying cause of death should always be an antecedent cause of death in every death certificate. Do you agree with this statement?	56 (32.1%)	50 (28.7%)	68 (39.2%)	Disagree
9. At least one antecedent cause of death should always be mentioned in every death certificate. Do you agree with this statement?	70 (40.2%)	63 (36.2%)	41 (23.6%)	Disagree
10. A contributory cause of death can be considered to be the underlying cause of death in certain cases. Do you agree with this statement?	61 (35.1%)	53 (30.4%)	60 (34.5%)	Disagree

Note: ^#Considered as wrong answer.