“A Switch In Time…”

….will not save you nine. A surefire way to trigger a request from the local vital statistics agency to amend a death certificate (DC) is to improperly enter time intervals in the “approximate interval: onset to death” column.  Amendment of a DC can be a time-consuming task for the busy clinician depending on the complexity of the patient’s medical condition and terminal clinical course. When read from top to bottom, time intervals should progressively increase  from most recent to farthest back in time, corresponding to the logical progression of complications of a given disease or condition listed next to it.


Now an end to your waiting with bated breath… the answers to the August 13, 2017 PPQ:

  1. False. Ethylene glycol (EG) will not be detected on routine in-hospital blood screens. It also will not be detected on alcohol (ethanol) screens. Rapid diagnosis and treatment of EG poisoning is critical but may be hindered by many things like incomplete or confounding history, non-specific lab results, early clinical presentation, or low index of clinical suspicion. EG fatalities related to missed or delayed diagnosis, both published and unpublished cases alike, are encountered by Medical/Examiner Coroner Offices 1.
  2. Many errors are present in the cause-of-death statement including illogical time intervals (the subject of this entry) and the inclusion of an injury-associated condition in a supposedly natural death.



  1. Armstrong EJ, Englehart DA, Jenkins AJ, Balraj EK. Homicidal ethylene glycol intoxication- a report of a case. Am J Forensic Med Pathol. 2006. June;27(2):151-55.


Be leery of the Query and for more tips on how to avoid errors on death certificates, consult Chapter 8 in the textbook Essentials In Death Reporting and Death Certification: Practical Applications for the Clinical Practitioner available on Amazon or for a direct link, click on: https://www.amazon.com/Essentials-Death-Reporting-Certification-Applications/dp/0998533408/ref=sr_1_1?ie=UTF8&qid=1488731535&sr=8-1&keywords=death+certification

Tune in next time for Practice Pearls!

Leave a Reply

Your email address will not be published. Required fields are marked *