Neeraj Shah1, Dean Jansen2 and Louise Restrick2
1Respiratory, Guy's & St. Thomas' NHS Foundation Trust, London, United Kingdom, 2Respiratory, Whittington Health, London, United Kingdom
Introduction: Mortality reduction strategies are informed by death certificates (DC). The aim of this study was to determine the contribution of respiratory disease and smoking to in-hospital deaths as recorded on DCs.
Methods: A retrospective analysis of all adult deaths (excluding those examined by the Coroner) at a inner-city hospital (April 2013-March 2014). Data was obtained from DCs and electronic records.
Results: 290 deaths (157M;133F) with mean (range) age 79 (37-105) years. 49% had a respiratory cause of death; 89% of these were pneumonia. These were recorded as bronchopneumonia (29%), aspiration pneumonia (28%), pneumonia (23%), hospital-acquired pneumonia (15%) and community-acquired pneumonia (6%). 11% pneumonia deaths had an underlying respiratory cause recorded; 35% a non-respiratory cause and 54% no underlying cause.
65% patients had been smokers; smoking status not recorded in 15%. 72% died of a disease where smoking is causative. Smoking history was recorded as contributory on 11% of DCs with mean 50 pack-years.
Conclusions: Half of in-patient deaths were due to a respiratory disease, the majority as pneumonia. However, no underlying cause of pneumonia was recorded in more than half. Where recorded, non-respiratory causes of pneumonia were three times more common than respiratory causes. A smoking-attributable cause of death was documented for 72% patients but smoking history was only recorded for 9%. These data make the case for increased clinician leadership in training/supervision of death certification focusing on documentation of the underlying diseases resulting in pneumonia and recording where smoking is a contributing cause of death.