Clinico-pathological discrepancies in the diagnosis of causes of death in adults in Mozambique: A retrospective observational study
| Autor: | Miguel J. Martínez, Paola Castillo, Mamudo R. Ismail, Lucilia Lovane, Cinta Moraleda, Eusebio Macete, Inacio Mandomando, Carla Carrilho, Tacilta Nhampossa, Anelsio Cossa, Rosa Bene, Clara Menéndez, Dercio Jordao, Khá Tia Munguambe, Jordi Vila, Fabiola Fernandes, Assucena Guisseve, Natalia Rakislova, Lorena Marimon, Juan Carlos Hurtado, Maria Maixenchs, Cesaltina Lorenzoni, Alberto L. García-Basteiro, Ariadna Sanz, Mireia Navarro, Emili Letang, Quique Bassat, Pedro L. Alonso, Rosauro Varo, Llorenç Quintó, Jaume Ordi |
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| Přispěvatelé: | Universitat de Barcelona, Graduate School, APH - Global Health, APH - Methodology |
| Předmět: |
RNA viruses
Male Pediatrics Autopsy Pathology and Laboratory Medicine Tertiary Care Centers 0302 clinical medicine Immunodeficiency Viruses Cause of Death Medicine and Health Sciences 030212 general & internal medicine Medical diagnosis Mozambique Cause of death Multidisciplinary HIV diagnosis and management Middle Aged Malalties -- Moçambic Infectious Diseases Oncology Medical Microbiology Viral Pathogens 030220 oncology & carcinogenesis Viruses Tuberculosis Diagnosis and Management Medicine Female Autòpsia Pathogens Research Article Adult medicine.medical_specialty Tuberculosis Adolescent Science Surgical and Invasive Medical Procedures Salut pública -- Moçambic Tertiary referral hospital Microbiology Communicable Diseases 03 medical and health sciences Malignant Tumors Diagnostic Medicine Retroviruses Cancer Detection and Diagnosis medicine Humans Diagnostic Errors Microbial Pathogens Aged Moçambic -- Mortalitat business.industry Lentivirus Organisms Bacterial pneumonia Cancers and Neoplasms Biology and Life Sciences HIV Retrospective cohort study medicine.disease Verbal autopsy Mort (Biologia) Death (Biology) business |
| Zdroj: | Recercat. Dipósit de la Recerca de Catalunya instname PLoS ONE, 14(9):e0220657. Public Library of Science PLoS ONE, Vol 14, Iss 9, p e0220657 (2019) PLoS ONE Dipòsit Digital de la UB Universidad de Barcelona |
| Popis: | Background Clinico-pathological discrepancies are more frequent in settings in which limited diagnostic techniques are available, but there is little information on their actual impact. Aim We assessed the accuracy of the clinical diagnoses in a tertiary referral hospital in sub-Saharan Africa by comparison with post-mortem findings. We also identified potential risk factors for misdiagnoses. Methods One hundred and twelve complete autopsy procedures were performed at the Maputo Central Hospital (Mozambique), from November 2013 to March 2015. We reviewed the clinical records. Major clinico-pathological discrepancies were assessed using a modified version of the Goldman and Battle classification. Results Major diagnostic discrepancies were detected in 65/112 cases (58%) and were particularly frequent in infection-related deaths (56/80 [70%] major discrepancies). The sensitivity of the clinical diagnosis for toxoplasmosis was 0% (95% CI: 0-37), 18% (95% CI: 2-52) for invasive fungal infections, 25% (95% CI: 5-57) for bacterial sepsis, 34% (95% CI: 16-57), for tuberculosis, and 46% (95% CI: 19-75) for bacterial pneumonia. Major discrepancies were more frequent in HIV-positive than in HIV-negative patients (48/73 [66%] vs. 17/39 [44%]; p = 0.0236). Conclusions Major clinico-pathological discrepancies are still frequent in resource constrained settings. Increasing the level of suspicion for infectious diseases and expanding the availability of diagnostic tests could significantly improve the recognition of common life-threatening infections, and thereby reduce the mortality associated with these diseases. The high frequency of clinico-pathological discrepancies questions the validity of mortality reports based on clinical data or verbal autopsy. |
| Databáze: | OpenAIRE |
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