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Logo of mjafiGuide for AuthorsAbout this journalExplore this journalMedical Journal, Armed Forces India
Med J Armed Forces India. 2000 January; 56(1): 88.
Published online 2017 June 8. doi:  10.1016/S0377-1237(17)30110-7
PMCID: PMC5532001


Dear Editor,

This is with reference to the article “Developing an operational decision rule for identifying the fatal case documents at risk of being returned through mathematical modelling” by Mishra, Matwankar and Bhalwar [1].

The authors have omitted to mention how many fatal case documents were subjected to evaluation by this mathematical model and whether the evaluation was prospective or retrospective.

The authors’ contention that “The mathematical model was developed using statistical procedures which have already been validated in a large scale study in Armed Forces”, has to be accepted with caution because the basis used to develop a model validated under one set of conditions may not be valid under another set of conditions. In fact the authors have quoted a model used to predict hypertension at high altitude which has no relation whatsoever to fatal case documents [2].

The sensitivity of 53% of this model indicates that almost half the fatal case documents at risk of being returned will be missed. Thus the utility of this model is questionable.

In fact, except for the time lag factor, all other variables used in operating this model are non-modifiable and beyond the control of the specialist in charge of the case. As such it is not understood as to how and what a ‘a priori’ action can be taken on documents identified at risk of being returned. A mathematical model identifying factors that can be modified by the specialist concerned would facilitate ‘a priori’ corrective action.

The mathematical model developed by the authors was used to calculate the probability of documents being returned in ten possible situations. From an analysis of the results obtained after calculation, it appears that regardless of age and time factor, the documents of personnel who were serving at the time of demise stands a high chance of being returned. Conversely, the chances of the documents of all other categories of personnel stand less chance of being returned. Does this imply that the documents of personnel serving at the time of their demise are scrutinized more carefully by higher authorities than those of other categories of personnel?

While the authors statement that this model is simple enough to be used by even a junior clerk may be correct, in our opinion it serves no useful purpose because of the inherent pitfalls. Moreover, armed with this model, the individual is likely to blindly apply it and thereby ignore the routine checking of fatal case documents that is in practice now. This will, in fact, result in more documents being returned by higher authorities, thereby defeating the purpose of this model.


1. Mishra UB, Matwankar SKP, Bhalwar R. Developing an operational decision rule for identifying the fatal case documents at risk of being returned through mathematical modelling. Medical Journal Armed Forces India. 1998;54:47–48.
2. Bhalwar R, Sandhu HS, Ahuja RC, Singh GK, Misra RP. Clinico-epidemiological algorithm for predicting systemic arterial hypertension at high altitude through mathematical modelling. Medical Journal Armed Forces India. 1994;50:175–180.

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