Title
Postmortem Interval and Diagnostic Performance of the Autopsy Methods
Date Issued
01 December 2018
Access level
open access
Resource Type
journal article
Author(s)
Quintó L.
Castillo P.
Carrilho C.
Fernandes F.
Jordao D.
Lovane L.
Navarro M.
Casas I.
Bene R.
Nhampossa T.
Santos Ritchie P.
Bandeira S.
Sambo C.
Chicamba V.
Mocumbi S.
Jaze Z.
Mabota F.
Ismail M.R.
Lorenzoni C.
Guisseve A.
Rakislova N.
Marimon L.
Castrejon N.
Sanz A.
Cossa A.
Mandomando I.
Munguambe K.
Maixenchs M.
Muñoz-Almagro C.
Macete E.
Alonso P.
Vila J.
Bassat Q.
Menéndez C.
Martínez M.J.
Ordi J.
Universidad de Barcelona
Publisher(s)
Nature Publishing Group
Abstract
Postmortem studies, including the complete diagnostic autopsy (CDA) and the minimally invasive autopsy (MIA), an innovative approach to post-mortem sampling and cause of death investigation, are commonly performed within 24 hours after death because the quality of the tissues deteriorates over time. This short timeframe may hamper the feasibility of the procedure. In this study, we compared the diagnostic performance of the two postmortem procedures when carried out earlier and later than 24 hours after death, as well as the impact of increasing postmortem intervals (PMIs) on the results of the microbiological tests in a series of 282 coupled MIA/CDA procedures performed at the Maputo Central Hospital in Mozambique between 2013 and 2015. 214 procedures were conducted within 24 hours of death (early autopsies), and 68 after 24 hours of death (late autopsies). No significant differences were observed in the number of non-conclusive diagnoses (2/214 [1%] vs. 1/68 [1%] p = 0.5645 for the CDA; 27/214 [13%] vs. 5/68 [7%] p = 0.2332 for the MIA). However, increasing PMIs were associated with a raise in the number of bacteria identified (rate: 1.014 per hour [95%CI: 1.002–1.026]; p = 0.0228). This increase was mainly due to rising numbers of bacteria of the Enterobacteriaceae family and Pseudomonas genus strains. Thus, performing MIA or CDA more than 24 hours after death can still render reliable diagnostic results, not only for non-infectious conditions but also for many infectious diseases, although, the contribution of Enterobacteriaceae and Pseudomonas spp. as etiological agents of infections leading to death may be overestimated.
Volume
8
Issue
1
Language
English
OCDE Knowledge area
Pediatría Otras ciencias médicas
Scopus EID
2-s2.0-85055792639
PubMed ID
Source
Scientific Reports
ISSN of the container
20452322
Sponsor(s)
We would like to thank the families of the deceased patients included in this study. The authors are grateful to all the members of the Department of Pathology of Maputo Central Hospital, whose support made this study possible, and to the staff of the Centro de Investigação em Saúde de Manhiça (CISM) for their logistic support. We specifically thank Mr. Bento Nhancale for his invaluable support to the study. We also thank the European Society for Clinical Microbiology and Infectious Diseases Study Group for Forensic and Postmortem Microbiology (ESGFOR) for valuable training and advice. The CaDMIA research project (Validation of the minimally invasive autopsy tool for cause of death investigation in developing countries) was funded by the Bill & Melinda Gates Foundation (Global Health grant numbers OPP1067522; QB) (http://www.gatesfoundation.org/) and by the Spanish Instituto de Salud Carlos III (FIS, PI12/00757; CM) (https://portalfis.isciii.es). Data analysis has been supported by the CaDMIA plus research project, funded by the Bill & Melinda Gates Foundation (Global health grant numbers OPP1128001; JO) (http://www.gatesfoundation.org) and the Spanish Instituto de Salud Carlos III (Acciones CIBER; CM) (http://www.ciberisciii.es/). ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya (http://cerca.cat/en/suma/). CISM is supported by the Government of Mozambique and the Spanish Agency for International Development (AECID). No funding bodies had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Sources of information: Directorio de Producción Científica Scopus