Objective: To evaluate the accuracy of death certification in patients with PD.

Background: The National Statistics Office guidance (1) suggests that doctors completing Medical Certificate for cause of Death (MCCD) in England and Wales should record the accurate cause of death. Doctors should record the sequence leading to death, underlying cause and contributory causes as below: Table(1)Parkinson’s disease (PD) is a progressive neurodegenerative disease associated with increased mortality(2). Recent studies have shown sub-optimal documentation of PD as primary or underlying cause of death (3).

Method: PD patients who had passed away in  Royal Berkshire hospital between 1st January and 31st December 2017 were identified by Medical Informatics. Demographic data, admitting symptoms, frailty markers , swallowing impairment, cause of death as documented on MCCD was collected on a proforma. Information was gathered from clinical notes, clinic letters on electronic patient records and Neurology data base.

Results: A total of 38 patients (33 males) were identified with an age range of 61-95 years (average 80.5 years) .PD duration was 1-18 years (average 7 years). 42 % (16/38) had an impaired swallow.Table(2)In 52 % (20/38) of PD patients, the death was related to a respiratory cause.34 %(13/38) died of Aspiration pneumonia and PD was mentioned in 1(b) in only 46%(6/13). PD was documented in part II for 65% (25/38) of patients.Table(2)In 52 % (20/38) of PD patients, the death was related to a respiratory cause.34 %(13/38) died of Aspiration pneumonia and PD was mentioned in 1(b) in only 46%(6/13). PD was documented in part II for 65% (25/38) of patients.Table (2)In 52 % (20/38) of PD patients, the death was related to a respiratory cause.34 %(13/38) died of Aspiration pneumonia and PD was mentioned in 1(b) in only 46%(6/13). PD was documented in part II for 65% (25/38) of patients.

Conclusion: As Pneumonia is a leading cause of death in PD patients and prompt assessment of swallowing should be made in hospitalized patients. Education of doctors regarding the correct documentation in MCCD is essential, particularly in recording PD in 1(b) for cases of Aspiration Pneumonia.

References: 1 Guidance for doctors completing Medical Certificates of Cause of Death in England and Wales- National Statistics’ Death Certification Advisory Group, Revised July 2010 2 Macleod AD, Taylor KS, Counsell CE. Mortality in Parkinson’s disease: a systematic review and meta-analysis. Mov Disord. 3 Mortality and quality of death certification in a cohort of patients with Parkinson’s disease and matched controls in North Wales, UK at 18 years: a community-based cohort study BMJ Open 2018; 8:e018969. doi: 10.1136/bmjopen-2017-018969

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MDS Abstracts - https://www.mdsabstracts.org/abstract/certification-of-cause-of-death-in-patients-with-parkinsons-disease-pd/