Indian Council of Medical Research (ICMR) releases fresh set of guidelines-Categorise cause of death, focus on sequence of events
- ICMR released fresh guidelines in the wake of COVID-19 pandemic.
- These outline a new standardised form where medical practitioners have to categorise the death’s immediate cause, antecedent cause, and other significant conditions in separate columns.
- These were issued as India’s Covid-19 death count surpasses 2,000 people.
TYPES OF CAUSES- EXPLAINED
- The immediate cause is the “disease, injury, or complication that caused the death, not the mode of dying”.
- The antecedent cause is the morbid condition(s) that “gave rise to the immediate cause”.
- The other significant conditions are those that “contributed to the death but are not related to the disease or to the condition causing it”.
- It is likely that Covid-19 is the Underlying Cause Of Death (UCOD) that lead to ARDS (Acute Respiratory Disease Syndrome) or Pneumonia in most of the deaths due to Covid-19 (test positive and symptoms positive). In these cases Covid-19 must be captured (under antecedent cause).
TYPES OF DEATHS
- Deaths with inconclusive test results, but in which coronavirus symptoms are present will be recorded as “probable COVID-19” fatalities.
- Deaths in which tests are awaited with the presence of symptoms will be recorded as suspected deaths, while those testing negative but have symptoms will be mentioned as clinically-epidemiologically diagnosed COVID-19.
- Deaths in hospital and under medical care due to Covid-19 is a Non-MLC (non medico legal) case and doesn’t require postmortem examination and the required certification of death is being done by treating doctors.
- In case of a suspected Covid-19 death that is labelled a medico legal case by an emergency doctor, forensic autopsy may be waived.
OTHER IMPORTANT GUIDELINES
- The logical sequence of events must be clearly articulated in the records.
- Only those conditions that have contributed to death should be recorded.
- Patients may present with other pre-existing comorbid conditions such as chronic obstructive pulmonary disease (COPD) or asthma, chronic bronchitis, ischemic heart disease, cancer and diabetes mellitus. These conditions increase the risk of developing respiratory infections, and may lead to complications and severe disease in a Covid-19 positive individual. These conditions are not considered as (underlying cause of death) as they have directly not caused death due to Covid-19.
ICMR-NCDIR e-Mortality (e-Mor) software
- It is a software that should be used for recording the cause of death.
- This software can be implemented by hospitals and district local registrar offices in a district (to record deaths occurring in residence).
- Institutions should register with ICMR-NCDIR or state authority for provision of authorised login credentials.
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