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 us...
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| Veröffentlicht in: | Human pathology 2019-03, Vol.85, p.184-193 |
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| creator | Fernandes, Fabiola Castillo, Paola Bassat, Quique Quintó, Llorenç Hurtado, Juan Carlos Martínez, Miguel J. Lovane, Lucilia Jordao, Dercio Bene, Rosa Nhampossa, Tacilta Ritchie, Paula Santos Bandeira, Sónia Sambo, Calvino Chicamba, Valeria Mocumbi, Sibone Jaze, Zara Mabota, Flora Ismail, Mamudo R. Lorenzoni, Cesaltina Sanz, Ariadna Rakislova, Natalia Marimon, Lorena Cossa, Anelsio Mandomando, Inacio Vila, Jordi Maixenchs, Maria Munguambe, Khátia Macete, Eusebio Alonso, Pedro Menéndez, Clara Ordi, Jaume Carrilho, Carla |
| description | 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.
•The addition of clinical data increases the diagnostic accuracy of the minimally invasive autopsy (MIA) and complete diagnostic autopsy in 12% and 8% of the cases, respectively.•The increase in concordance from MIA blind to clinical data to MIA enhanced with clinical data was significant in neonatal, adult, and maternal deaths and was also evident in children, although it did not reach statistical significance.•The use of clinical data may improve the diagnostic precision of the MIA in resource-limited settings. |
| doi_str_mv | 10.1016/j.humpath.2018.10.037 |
| format | Article |
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•The addition of clinical data increases the diagnostic accuracy of the minimally invasive autopsy (MIA) and complete diagnostic autopsy in 12% and 8% of the cases, respectively.•The increase in concordance from MIA blind to clinical data to MIA enhanced with clinical data was significant in neonatal, adult, and maternal deaths and was also evident in children, although it did not reach statistical significance.•The use of clinical data may improve the diagnostic precision of the MIA in resource-limited settings.</description><identifier>ISSN: 0046-8177</identifier><identifier>EISSN: 1532-8392</identifier><identifier>DOI: 10.1016/j.humpath.2018.10.037</identifier><identifier>PMID: 30496801</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdomen ; Accuracy ; Adolescent ; Adult ; Age ; Aged ; Animal bites ; Autopsy - methods ; Cardiomyopathy ; Cardiovascular disease ; Cause of death determination ; Child ; Child, Preschool ; Complete diagnostic autopsy ; Death ; Diabetes ; Esophagus ; Female ; Fluids ; Heart attacks ; Hemorrhage ; Hospitals ; Humans ; Hypertension ; Infant ; Infant, Newborn ; International Classification of Diseases, Tenth Revision ; Kidneys ; Laboratories ; Low income groups ; Male ; Maternal mortality ; Middle Aged ; Minimally invasive autopsy ; Pathology ; Placenta ; Pregnancy ; Rabies ; Resource-limited settings ; Sepsis ; Spleen ; Studies ; Ulcers ; Young Adult</subject><ispartof>Human pathology, 2019-03, Vol.85, p.184-193</ispartof><rights>2018 The Authors</rights><rights>Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>2018. The Authors</rights><rights>2018 The Authors 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4107-64db8dbe7d005deaf348486629cf45959afa79c25c0d2e3f683c606ac3db1a1c3</citedby><cites>FETCH-LOGICAL-c4107-64db8dbe7d005deaf348486629cf45959afa79c25c0d2e3f683c606ac3db1a1c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0046817718304416$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30496801$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fernandes, Fabiola</creatorcontrib><creatorcontrib>Castillo, Paola</creatorcontrib><creatorcontrib>Bassat, Quique</creatorcontrib><creatorcontrib>Quintó, Llorenç</creatorcontrib><creatorcontrib>Hurtado, Juan Carlos</creatorcontrib><creatorcontrib>Martínez, Miguel J.</creatorcontrib><creatorcontrib>Lovane, Lucilia</creatorcontrib><creatorcontrib>Jordao, Dercio</creatorcontrib><creatorcontrib>Bene, Rosa</creatorcontrib><creatorcontrib>Nhampossa, Tacilta</creatorcontrib><creatorcontrib>Ritchie, Paula Santos</creatorcontrib><creatorcontrib>Bandeira, Sónia</creatorcontrib><creatorcontrib>Sambo, Calvino</creatorcontrib><creatorcontrib>Chicamba, Valeria</creatorcontrib><creatorcontrib>Mocumbi, Sibone</creatorcontrib><creatorcontrib>Jaze, Zara</creatorcontrib><creatorcontrib>Mabota, Flora</creatorcontrib><creatorcontrib>Ismail, Mamudo R.</creatorcontrib><creatorcontrib>Lorenzoni, Cesaltina</creatorcontrib><creatorcontrib>Sanz, Ariadna</creatorcontrib><creatorcontrib>Rakislova, Natalia</creatorcontrib><creatorcontrib>Marimon, Lorena</creatorcontrib><creatorcontrib>Cossa, Anelsio</creatorcontrib><creatorcontrib>Mandomando, Inacio</creatorcontrib><creatorcontrib>Vila, Jordi</creatorcontrib><creatorcontrib>Maixenchs, Maria</creatorcontrib><creatorcontrib>Munguambe, Khátia</creatorcontrib><creatorcontrib>Macete, Eusebio</creatorcontrib><creatorcontrib>Alonso, Pedro</creatorcontrib><creatorcontrib>Menéndez, Clara</creatorcontrib><creatorcontrib>Ordi, Jaume</creatorcontrib><creatorcontrib>Carrilho, Carla</creatorcontrib><title>Contribution of the clinical information to the accuracy of the minimally invasive and the complete diagnostic autopsy</title><title>Human pathology</title><addtitle>Hum Pathol</addtitle><description>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.
•The addition of clinical data increases the diagnostic accuracy of the minimally invasive autopsy (MIA) and complete diagnostic autopsy in 12% and 8% of the cases, respectively.•The increase in concordance from MIA blind to clinical data to MIA enhanced with clinical data was significant in neonatal, adult, and maternal deaths and was also evident in children, although it did not reach statistical significance.•The use of clinical data may improve the diagnostic precision of the MIA in resource-limited settings.</description><subject>Abdomen</subject><subject>Accuracy</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Animal bites</subject><subject>Autopsy - methods</subject><subject>Cardiomyopathy</subject><subject>Cardiovascular disease</subject><subject>Cause of death determination</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Complete diagnostic autopsy</subject><subject>Death</subject><subject>Diabetes</subject><subject>Esophagus</subject><subject>Female</subject><subject>Fluids</subject><subject>Heart attacks</subject><subject>Hemorrhage</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>International Classification of Diseases, Tenth Revision</subject><subject>Kidneys</subject><subject>Laboratories</subject><subject>Low income groups</subject><subject>Male</subject><subject>Maternal mortality</subject><subject>Middle Aged</subject><subject>Minimally invasive autopsy</subject><subject>Pathology</subject><subject>Placenta</subject><subject>Pregnancy</subject><subject>Rabies</subject><subject>Resource-limited settings</subject><subject>Sepsis</subject><subject>Spleen</subject><subject>Studies</subject><subject>Ulcers</subject><subject>Young 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invasive and the complete diagnostic autopsy</atitle><jtitle>Human pathology</jtitle><addtitle>Hum Pathol</addtitle><date>2019-03</date><risdate>2019</risdate><volume>85</volume><spage>184</spage><epage>193</epage><pages>184-193</pages><issn>0046-8177</issn><eissn>1532-8392</eissn><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.
•The addition of clinical data increases the diagnostic accuracy of the minimally invasive autopsy (MIA) and complete diagnostic autopsy in 12% and 8% of the cases, respectively.•The increase in concordance from MIA blind to clinical data to MIA enhanced with clinical data was significant in neonatal, adult, and maternal deaths and was also evident in children, although it did not reach statistical significance.•The use of clinical data may improve the diagnostic precision of the MIA in resource-limited settings.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30496801</pmid><doi>10.1016/j.humpath.2018.10.037</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Human pathology, 2019-03, Vol.85, p.184-193 |
| issn | 0046-8177 1532-8392 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6478426 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Abdomen Accuracy Adolescent Adult Age Aged Animal bites Autopsy - methods Cardiomyopathy Cardiovascular disease Cause of death determination Child Child, Preschool Complete diagnostic autopsy Death Diabetes Esophagus Female Fluids Heart attacks Hemorrhage Hospitals Humans Hypertension Infant Infant, Newborn International Classification of Diseases, Tenth Revision Kidneys Laboratories Low income groups Male Maternal mortality Middle Aged Minimally invasive autopsy Pathology Placenta Pregnancy Rabies Resource-limited settings Sepsis Spleen Studies Ulcers Young Adult |
| title | Contribution of the clinical information to the accuracy of the minimally invasive and the complete diagnostic autopsy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-27T17%3A25%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Contribution%20of%20the%20clinical%20information%20to%20the%20accuracy%20of%20the%20minimally%20invasive%20and%20the%20complete%20diagnostic%20autopsy&rft.jtitle=Human%20pathology&rft.au=Fernandes,%20Fabiola&rft.date=2019-03&rft.volume=85&rft.spage=184&rft.epage=193&rft.pages=184-193&rft.issn=0046-8177&rft.eissn=1532-8392&rft_id=info:doi/10.1016/j.humpath.2018.10.037&rft_dat=%3Cproquest_pubme%3E2203684144%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2203684144&rft_id=info:pmid/30496801&rft_els_id=S0046817718304416&rfr_iscdi=true |