Abstract
SummaryAlthough 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.
Highlights
The autopsy is the gold standard methodology for cause of death investigation
The concordance between the diagnostic categories obtained in the MIA blind to clinical data (MIAb), MIA adding the clinical information (MIAc), and CDAb with the gold standard (CDAc) was evaluated by means of the κ coefficient, which was interpreted as suggested by Landis and Koch [15]
The minimally invasive autopsy (MIA) and the complete diagnostic autopsy (CDA) performed and analyzed blindly to any clinical data have a good correlation with the gold standard, the addition of clinical information to the pathological and microbiological findings results in a minor but significant increase in the concordance in the diagnostic group and in higher coincidence between the MIA and the CDA with the gold standard diagnosis (CDA with clinical data)
Summary
The autopsy is the gold standard methodology for cause of death investigation. It is a valuable tool to maintain accurate mortality statistics, which remain essential for public health and health service planning. Autopsy rates, which have markedly declined in Western countries in the last decades, have always been very low in low-income countries. The feasibility of conducting autopsies in these sites faces notable barriers including cultural and/or religious apprehension, which lead to a poor acceptability of the conventional autopsy procedure [1,2]. The lack of infrastructures and the low number of trained pathologists are a limitation for a time-consuming examination such as complete diagnostic autopsy (CDA). The fact that many deaths occur outside the health system [3] results in a serious constraint for autopsy practice in low-income countries
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