Death following traumatic intracranial haemorrhage — MRCEM SBA MCQ

Instant feedback + full explanation. One question, done properly.

EasyProfessional practice and researchDeath following traumatic intracranial haemorrhageMRCEM SBA

An 81-year-old man is brought to an emergency department in England after a witnessed fall at home. He struck his head and was initially able to speak. CT shows an extensive acute traumatic subdural haemorrhage. Despite treatment, he dies in the department. The treating doctor is confident that the haemorrhage caused his death, and there is no suspicion of assault. What is the most appropriate next step in the death-certification process?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Notify the coroner, providing the history of the fall and CT findings.

The witnessed head strike and CT-confirmed traumatic subdural haemorrhage establish that injury caused this death. A death due to trauma must be notified to the coroner even when the accident was witnessed, the medical cause is known and assault is not suspected. The coroner decides whether an investigation is required; if not, the death can return to the medical certification route. ([assets.publishing.service.gov.uk](https://assets.publishing.service.gov.uk/media/66d044a059b0ec2e151f847e/Guidance_for_registered_medical_practitioners_on_the_Notification_of_Deaths_Regulations__web_.pdf)) A is attractive because medical examiners scrutinise non-coronial deaths, but accidental injury does not remove the notification requirement. C confuses certainty about the medical cause with eligibility to proceed directly to an MCCD; certification may follow if the coroner decides not to investigate. D would be reasonable if it were genuinely uncertain whether the injury contributed to death, but the causal link is explicit here. E would be appropriate if the circumstances suggested a crime; a witnessed accidental fall provides no such indication, and police notification would not replace the doctor's coroner notification. ([gov.uk](https://www.gov.uk/government/publications/medical-certificate-of-cause-of-death-mccd-guidance-for-medical-practitioners/guidance-for-medical-practitioners-completing-medical-certificates-of-cause-of-death-in-england-and-wales))

Reference: Guidance for medical practitioners completing medical certificates of cause of death in England and Wales (8 April 2025) — https://www.gov.uk/government/publications/medical-certificate-of-cause-of-death-mccd-guidance-for-medical-practitioners/guidance-for-medical-practitioners-completing-medical-certificates-of-cause-of-death-in-england-and-wales Notification of Deaths Regulations 2019 guidance (9 September 2024) — https://www.gov.uk/government/publications/notification-of-deaths-regulations-2019-guidance