Title
Contribution of the clinical information to the accuracy of the minimally invasive and the complete diagnostic autopsy
Date Issued
01 March 2019
Access level
open access
Resource Type
journal article
Author(s)
Fernandes F.
Castillo P.
Bassat Q.
Quintó L.
Martínez M.J.
Lovane L.
Jordao D.
Bene R.
Nhampossa T.
Ritchie P.S.
Bandeira S.
Sambo C.
Chicamba V.
Mocumbi S.
Jaze Z.
Mabota F.
Ismail M.R.
Lorenzoni C.
Sanz A.
Rakislova N.
Marimon L.
Cossa A.
Mandomando I.
Vila J.
Maixenchs M.
Munguambe K.
Macete E.
Alonso P.
Menéndez C.
Ordi J.
Carrilho C.
Universidad de Barcelona
Publisher(s)
W.B. Saunders
Abstract
Although autopsy diagnosis includes routinely, a thorough evaluation of all available pathological results and also of any available clinical data, the contribution of this clinical information to the diagnostic yield of the autopsy has not been analyzed. We aimed to determine to which degree the use of clinical data improves the diagnostic accuracy of the complete diagnostic autopsy (CDA) and the minimally invasive autopsy (MIA), a simplified pathological postmortem procedure designed for low-income sites. A total of 264 coupled MIA and CDA procedures (112 adults, 57 maternal deaths, 54 children, and 41 neonates) were performed at the Maputo Hospital, Mozambique. We compared the diagnoses obtained by the MIA blind to clinical data (MIAb), the MIA adding the clinical information (MIAc), and the CDA blind to clinical information (CDAb), with the results of the gold standard, the CDA with clinical data, by comparing the International Classification of Diseases, Tenth Revision codes and the main diagnostic classes obtained with each evaluation strategy (MIAb, MIAc, CDAb, CDAc). The clinical data increased diagnostic coincidence to the MIAb with the gold standard in 30 (11%) of 264 cases and modified the CDAb diagnosis in 20 (8%) of 264 cases. The increase in concordance between MIAb and MIAc with the gold standard was significant in neonatal deaths (κ increasing from 0.404 to 0.618, P =.0271), adult deaths (κ increasing from 0.732 to 0.813, P =.0221), and maternal deaths (κ increasing from 0.485 to 0.836, 0.;P <.0001). In conclusion, the use of clinical information increases the precision of MIA and CDA and may strengthen the performance of the MIA in resource-limited settings.
Start page
184
End page
193
Volume
85
Language
English
OCDE Knowledge area
Otras ciencias médicas Patología
Scopus EID
2-s2.0-85061754045
PubMed ID
Source
Human Pathology
ISSN of the container
00468177
Sponsor(s)
Funding/Support: This work was funded by the Bill & Melinda Gates Foundation (Global Health Grant Nos. OPP1067522 and OPP1128001) and by the Spanish Instituto de Salud Carlos III (FIS; PI12/00757; CM, Acciones CIBER). ISGlobal is included in the CERCA Programme/Generalitat de Catalunya. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Sources of information: Directorio de Producción Científica Scopus