Performance of the minimally invasive autopsy tool for cause of death determination in adult deaths from the Brazilian Amazon: an observational study
Por:
Palhares AEM, Ferreira L, Freire M, Castillo P, Martínez MJ, Hurtado JC, Rakislova N, Varo R, Navarro-Aguirre M, Casas I, Vila J, Monteiro WM, Sanz A, Quintó L, Fernandes F, Carrilho C, Menéndez C, Ordi J, Bassat Q and Lacerda M
Publicada:
1 nov 2019
Ahead of Print:
14 jun 2019
Resumen:
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 = 0.777, 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 = 0.311, 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.
Filiaciones:
Palhares AEM:
Universidade do Estado do Amazonas, Manaus, Amazonas, 69850-000, Brazil
Ferreira L:
Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, 69040-000, Brazil
Freire M:
Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, 69040-000, Brazil
Castillo P:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Department of Pathology, Hospital Clinic - Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Martínez MJ:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Department of Microbiology, Hospital Clinic - Universitat de Barcelona, 08036, Barcelona, Spain
Hurtado JC:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Department of Microbiology, Hospital Clinic - Universitat de Barcelona, 08036, Barcelona, Spain
Rakislova N:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Department of Pathology, Hospital Clinic - Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Centro de Investigação em Saúde de Manhiça (CISM), 1929, Maputo, Mozambique
Navarro-Aguirre M:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Casas I:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Department of Microbiology, Hospital Clinic - Universitat de Barcelona, 08036, Barcelona, Spain
Monteiro WM:
Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, 69040-000, Brazil
National Council for Scientific and Technological Development (CNPq, Brasilia, Brazil) fellow, Brasília, Brazil
Sanz A:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Quintó L:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Fernandes F:
Department of Pathology, Maputo Central Hospital, 1653, Maputo, Mozambique
Faculty of Medicine, Eduardo Mondlane University, 1653, Maputo, Mozambique
Carrilho C:
Department of Pathology, Maputo Central Hospital, 1653, Maputo, Mozambique
Faculty of Medicine, Eduardo Mondlane University, 1653, Maputo, Mozambique
Menéndez C:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain
Centro de Investigação em Saúde de Manhiça (CISM), 1929, Maputo, Mozambique
Ordi J:
ISGlobal-Hospital Clínic, Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
Department of Pathology, Hospital Clinic - Universitat de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
Bassat Q:
Centro de Investigação em Saúde de Manhiça (CISM), 1929, Maputo, Mozambique
ICREA, Catalan Institution for Research and Advanced Studies, Passeig de Lluís Companys 23, 08010, Barcelona, Spain
Paediatric Infectious Diseases Unit, Paediatrics Department, Hospital Sant Joan de Déu - Universitat de Barcelona, 8950, Barcelona, Spain
Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
Lacerda M:
Fundação de Medicina Tropical Dr. Heitor Viera Dourado, Manaus, 69040-000, Brazil
National Council for Scientific and Technological Development (CNPq, Brasilia, Brazil) fellow, Brasília, Brazil
Green Submitted, gold
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