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Title: Contribution of the clinical information to the accuracy of the minimally invasive and the complete diagnostic autopsy
Author: Fernandes, Fabiola
Castillo, Paola
Bassat Orellana, 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, Inácio
Vila Estapé, Jordi
Maixenchs, Maria
Munguambe, Khátia
Macete, Eusébio
Alonso, Pedro
Menéndez, Clara
Ordi i Majà, Jaume
Carrilho, Carla
Keywords: Autòpsia
Issue Date: 27-Nov-2018
Publisher: Elsevier
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. 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.
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It is part of: Human Pathology, 2019, vol. 85, p. 184-193
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ISSN: 0046-8177
Appears in Collections:Articles publicats en revistes (ISGlobal)

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