Performance of the minimally invasive autopsy tool for cause of death determination in adult deaths from the Brazilian Amazon: an observational study
The uncertainty about the real burden of causes of death (CoD) is increasingly recognized by the international health community as a critical limitation for prioritizing effective public health measures. The minimally invasive autopsy (MIA) has shown to be a satisfactory substitute of the complete d...
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Zusammenfassung: | The uncertainty about the real burden of causes of death
(CoD) is increasingly recognized by the international health
community as a critical limitation for prioritizing effective
public health measures. The minimally invasive autopsy (MIA) has
shown to be a satisfactory substitute of the complete diagnostic
autopsy (CDA), the gold standard for CoD determination in low-
and middle-income countries. However, more studies are needed to
confirm its adequate performance in settings with different
epidemiology. In this observational study, the CoD obtained with
the MIA were compared with the clinical diagnosis and the
results of the CDA in 61 deaths that occurred in an infectious
diseases referral hospital in Manaus, Brazilian Amazon.
Concordance between the categories of diseases obtained by the
three methods was evaluated by the Kappa statistic.
Additionally, we evaluated discrepancies between clinical and
complete diagnostic autopsy diagnoses. The MIA showed a
substantial concordance with the CDA
(Kappa\xE2\x80\x89=\xE2\x80\x890.777, 95% CI 0.608-0.946), and a
perfect or almost perfect coincidence in specific diagnosis
(ICD-10 code) between MIA and CDA was observed in 85% of the
cases. In contrast, the clinical diagnosis showed a fair
concordance with the CDA (Kappa\xE2\x80\x89=\xE2\x80\x890.311,
95% CI 0.071-0.552). Major clinico-pathological discrepancies
were identified in 49% of cases. In conclusion, the MIA showed a
substantial performance for CoD identification.
Clinico-pathological discrepancies remain high and justify the
need for post-mortem studies, even in referral hospitals. The
MIA is a robust substitute of the CDA for CoD surveillance and
quality improvement of clinical practice in low- and
middle-income settings. |
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ISSN: | 0945-6317 |
DOI: | 10.1007/s00428-019-02602-z |