Sources of Information for Coding the Causes of Death

National Records of Scotland (NRS), formerly General Register Office for Scotland (GROS) classifies the underlying cause of death (in terms of the International Statistical Classification of Diseases and Related Health Problems) on the basis of the information collected on the death certificate together with any additional information provided by official sources, such as the doctor who certified the death (following a request from NRS for further details), pathologists, Procurators Fiscal or the Crown Office.

The medical certificate of cause of death is completed by a registered medical practitioner. While there are some general notes of guidance, including advice on points that should be covered and examples of the kinds of terminology that should (or should not) be used, the information that is recorded is a matter for the doctor's clinical judgment. The cause of death may be described as (e.g.) "unascertained pending test results" if a certificate is issued prior to the completion of histological or toxicological tests: if so, the doctor will be asked to provide more details later. 

In a case where the cause of death text appears insufficient to enable a death to be classified properly, NRS writes to the certifying doctor (e.g.) to request additional information about the death, or to ask for an apparent contradiction to be resolved.

In the case of drug-related deaths, NRS also seeks information from pathologists, including details of the substances that were thought to contribute to the death, other substances found in the body, and the pathologist's view of the causes of death. The form used for deaths in 2007 (and earlier years) asked the pathologist to indicate whether the overdose was believed to be accidental, suicidal, homicidal or unknown/uncertain, by ticking the appropriate box. The form used for deaths in 2008 (and later years) does not specifically request that information, but has a space for 'any other comments or information which may help in coding this death' - which pathologists sometimes use to write something like 'intentional self-harm'or 'deemed to be suicide'.

Generally, the Procurator Fiscal (PF) will enquire into any sudden, suspicious, accidental, unexpected or unexplained death. Doctors should report to the PF all deaths which may fall into certain categories, one of which is 'possible or suspected suicide'(refer to the Guidance to doctors on the Crown Office and Procurator Fiscal website), before issuing the death certificate (because, if a death certificate had been issued, and the PF did not accept the cause of death, the certificate would then have to be retrieved from the family, which could cause great distress). Deaths may also be reported to the PF by Registrars. The PF will then initiate further action, if appropriate (e.g. ask the police to investigate and report, request a post-mortem examination, etc), and inform NRS and/or the Registrar of the outcome - for example:

• confirm to NRS that no changes are required - the registered particulars are correct and complete;
• if the PF found that certain registered particulars were incorrect or incomplete, tell NRS what changes should be made to the cause of death text; and
• inform NRS that a Sheriff held an inquiry into the circumstances of the death and found that some of the registered particulars were incorrect or incomplete, and tell NRS how the cause of death text should be changed.

In the case of deaths which are thought to be suicides, PFs used to submit reports to the Crown Office, to enable decisions on the classification of deaths as suicides to be made consistently across Scotland. The Crown Office would then inform NRS if the death was considered to be a suicide.  However, PFs now notify NRS directly, by allocating each traumatic/suspicious death to one of the following ICD categories (which are defined in the Notes of Guidance of a PF form, which was revised for this purpose):

• accident;
• intentional self-harm;
• assault; and
• undetermined intent.

The revised form was used, on a 'pilot' basis, in three PF Areas in the first few months of 2009.  Some 'teething' troubles were identified: NRS and PF representatives agreed on changes to the form to deal with them, and it was then used by all PF Areas with effect from mid-2009.

Finally, each year, NRS obtains, from the relevant Scottish Government Statistics branches, information about each of the previous year's:

• victims of homicide; and
• road accident deaths.

NRS cross-checks its data against the details in these lists, and uses them (where appropriate) to improve its coding of the death. For example, the road accident statistics data records of deaths may include more detailed information about the types of vehicle involved in each accident than is available from the death certificates, enabling NRS to allocate ICD codes which relate to specific types of vehicle (rather than ones which do not indicate the vehicle type).