Evaluating the reliability of causes of death in published clinical research

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Abstract
All 879 papers published in 1994 in the Lancet, BMJ, Annals of Internal Medicine, and New England Journal of Medicine were reviewed; the methods used to evaluate the causes of death in each paper were recorded using 11 categories (table 1). Death was an outcome measure in 223 papers (25%). The two largest categories of papers were those in which causes of death were either unstated or stated without explanation of the method of ascertainment. The most common stated methods were clinical review committees and registries or databases. Forty two papers (19%) used one or more methods. A necropsy was used in only 29 papers (13%), and the proportion of deaths examined by necropsy varied widely (mean 60%; range 25-100); 15 of these papers failed to include the proportion that underwent necropsy. Four papers were based entirely on necropsy data.

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