Lines (b), (c), and (d) due to (or as a consequence of)
On line (b) report the disease, injury, or complication, if any, that gave rise
to the immediate cause of death reported on line (a). If this, in turn,
resulted from a further condition, record that condition on line (c). If this in
turn resulted from a further condition, record that condition on line (d).
For as many conditions as ar e involved, write the full sequence, one
condition per line, with the most recent condition at the top, and the
underlying cause of death reported on the lowest line used in Part I. If
more than four lines are needed, add additional lines (writing ‘‘due to’’
between conditions on the same line is the same as drawing an additional
line) rather than using space in Part II to continue the sequence. The
certification on page 18 is an example in which an additional line was
necessary.
The words ‘‘due to (or as a consequence of),’’ which are printed between the
lines of Part I, apply not only in sequences with an etiological or pathologi
cal basis and usually a chronological time ordering, but also to sequences
in which an antecedent condition is believed to have prepared the way for
a subsequent cause by damage to tissues or impairment of function.
If the immediate cause of death arose as a complication of or from an error
or accident in surgery or other medical procedure or treatment, it is
important to report what condition was being treated, what medical pro
cedure was performed, what the complication or error was, and what the
result of the complication or error was.
In case of injury, the for m of external violence or accident is antecedent to
an injury entered although the two events are almost simultaneous (for
example, automobile accident or fallen on by tree).
Approximate interval between onset and death
Space is provided to the right of lines (a), (b), (c), and (d) for recording the
interval between the presumed onset of the condition (not the diagnosis of
the condition) and the date of death. This should be entered for all condi
tions in Part I. These intervals usually are established by the medical
examiner or coroner on the basis of available information. In some cases
the interval will have to be estimated. The terms ‘‘unknown’’ or ‘‘approxi
mately’’ may be used. General terms, such as minutes, hours, or days, are
acceptable, if necessary. If the time of onset is entirely unknown, state that
the interval is ‘‘unknown.’’ Do not leave these items blank.
This information is useful in coding certain diseases and also provides a
useful check on the accuracy of the reported sequence of conditions.
16