20 research outputs found
Contribution of the clinical information to the accuracy of the minimally invasive and the complete diagnostic autopsy
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. 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 ICD-10
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 30/264 (11%) cases and modified the CDAb diagnosis
in 20/264 (8%) cases. The increase in concordance between MIAb
and MIAc with the gold standard was significant in neonatal
deaths (kappa increasing from 0.404 to 0.618, P=.0271), adult
deaths (kappa increasing from 0.732 to 0.813, P=.0221) and
maternal deaths (kappa increasing from 0.485 to 0.836,
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
Postmortem Interval and Diagnostic Performance of the Autopsy Methods
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
Validity of a minimally invasive autopsy tool for cause of death determination in pediatric deaths in Mozambique: An observational study
Background: In recent decades, the world has witnessed unprecedented progress in child survival. However, our knowledge of what is killing nearly 6 million children annually in low- and middle-income countries remains poor, partly because of the inadequacy and reduced precision of the methods currently utilized in these settings to investigate causes of death (CoDs). The study objective was to validate the use of a minimally invasive autopsy (MIA) approach as an adequate and more acceptable substitute for the complete diagnostic autopsy (CDA) for pediatric CoD investigation in a poor setting. Methods and findings: In this observational study, the validity of the MIA approach in determining the CoD was assessed in 54 post-neonatal pediatric deaths (age range: ≥1 mo to 15 y) in a referral hospital of Mozambique by comparing the results of the MIA with those of the CDA. Concordance in the category of disease obtained by the two methods was evaluated by the Kappa statistic, and the sensitivity, specificity, and positive and negative predictive values of the MIA diagnoses were calculated. A CoD was identified in all cases in the CDA and in 52/54 (96%) of the cases in the MIA, with infections and malignant tumors accounting for the majority of diagnoses. The MIA categorization of disease showed a substantial concordance with the CDA categorization (Kappa = 0.70, 95% CI 0.49-0.92), and sensitivity, specificity, and overall accuracy were high. The ICD-10 diagnoses were coincident in up to 75% (36/48) of the cases. The MIA allowed the identification of the specific pathogen deemed responsible for the death in two-thirds (21/32; 66%) of all deaths of infectious origin. Discrepancies between the MIA and the CDA in individual diagnoses could be minimized with the addition of some basic clinical information such as those ascertainable through a verbal autopsy or clinical record. The main limitation of the analysis is that both the MIA and the CDA include some degree of expert subjective interpretation. Conclusions: The MIA showed substantial concordance with CDA for CoD identification in this series of pediatric deaths in Mozambique. This minimally invasive approach, simpler and more readily acceptable than the more invasive CDA, could provide robust data for CoD surveillance, especially in resource-limited settings, which could be helpful for guiding child survival strategies in the future
Validity of a minimally invasive autopsy tool for cause of death determination in pediatric deaths in Mozambique: An observational study
Background: In recent decades, the world has witnessed unprecedented progress in child survival. However, our knowledge of what is killing nearly 6 million children annually in low- and middle-income countries remains poor, partly because of the inadequacy and reduced precision of the methods currently utilized in these settings to investigate causes of death (CoDs). The study objective was to validate the use of a minimally invasive autopsy (MIA) approach as an adequate and more acceptable substitute for the complete diagnostic autopsy (CDA) for pediatric CoD investigation in a poor setting. Methods and findings: In this observational study, the validity of the MIA approach in determining the CoD was assessed in 54 post-neonatal pediatric deaths (age range: ≥1 mo to 15 y) in a referral hospital of Mozambique by comparing the results of the MIA with those of the CDA. Concordance in the category of disease obtained by the two methods was evaluated by the Kappa statistic, and the sensitivity, specificity, and positive and negative predictive values of the MIA diagnoses were calculated. A CoD was identified in all cases in the CDA and in 52/54 (96%) of the cases in the MIA, with infections and malignant tumors accounting for the majority of diagnoses. The MIA categorization of disease showed a substantial concordance with the CDA categorization (Kappa = 0.70, 95% CI 0.49-0.92), and sensitivity, specificity, and overall accuracy were high. The ICD-10 diagnoses were coincident in up to 75% (36/48) of the cases. The MIA allowed the identification of the specific pathogen deemed responsible for the death in two-thirds (21/32; 66%) of all deaths of infectious origin. Discrepancies between the MIA and the CDA in individual diagnoses could be minimized with the addition of some basic clinical information such as those ascertainable through a verbal autopsy or clinical record. The main limitation of the analysis is that both the MIA and the CDA include some degree of expert subjective interpretation. Conclusions: The MIA showed substantial concordance with CDA for CoD identification in this series of pediatric deaths in Mozambique. This minimally invasive approach, simpler and more readily acceptable than the more invasive CDA, could provide robust data for CoD surveillance, especially in resource-limited settings, which could be helpful for guiding child survival strategies in the future
Contribution of the clinical information to the accuracy of the minimally invasive and the complete diagnostic autopsy
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. 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 ICD-10
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 30/264 (11%) cases and modified the CDAb diagnosis
in 20/264 (8%) cases. The increase in concordance between MIAb
and MIAc with the gold standard was significant in neonatal
deaths (kappa increasing from 0.404 to 0.618, P=.0271), adult
deaths (kappa increasing from 0.732 to 0.813, P=.0221) and
maternal deaths (kappa increasing from 0.485 to 0.836,
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
Validity of a minimally invasive autopsy tool for cause of death determination in pediatric deaths in Mozambique: An observational study
<div><p>Background</p><p>In recent decades, the world has witnessed unprecedented progress in child survival. However, our knowledge of what is killing nearly 6 million children annually in low- and middle-income countries remains poor, partly because of the inadequacy and reduced precision of the methods currently utilized in these settings to investigate causes of death (CoDs). The study objective was to validate the use of a minimally invasive autopsy (MIA) approach as an adequate and more acceptable substitute for the complete diagnostic autopsy (CDA) for pediatric CoD investigation in a poor setting.</p><p>Methods and findings</p><p>In this observational study, the validity of the MIA approach in determining the CoD was assessed in 54 post-neonatal pediatric deaths (age range: ≥1 mo to 15 y) in a referral hospital of Mozambique by comparing the results of the MIA with those of the CDA. Concordance in the category of disease obtained by the two methods was evaluated by the Kappa statistic, and the sensitivity, specificity, and positive and negative predictive values of the MIA diagnoses were calculated.</p><p>A CoD was identified in all cases in the CDA and in 52/54 (96%) of the cases in the MIA, with infections and malignant tumors accounting for the majority of diagnoses. The MIA categorization of disease showed a substantial concordance with the CDA categorization (Kappa = 0.70, 95% CI 0.49–0.92), and sensitivity, specificity, and overall accuracy were high. The ICD-10 diagnoses were coincident in up to 75% (36/48) of the cases. The MIA allowed the identification of the specific pathogen deemed responsible for the death in two-thirds (21/32; 66%) of all deaths of infectious origin. Discrepancies between the MIA and the CDA in individual diagnoses could be minimized with the addition of some basic clinical information such as those ascertainable through a verbal autopsy or clinical record. The main limitation of the analysis is that both the MIA and the CDA include some degree of expert subjective interpretation.</p><p>Conclusions</p><p>The MIA showed substantial concordance with CDA for CoD identification in this series of pediatric deaths in Mozambique. This minimally invasive approach, simpler and more readily acceptable than the more invasive CDA, could provide robust data for CoD surveillance, especially in resource-limited settings, which could be helpful for guiding child survival strategies in the future.</p></div
Postmortem Interval and Diagnostic Performance of the Autopsy Methods
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