Willingness to Know the Cause of Death and Hypothetical Acceptability of the Minimally Invasive Autopsy in Five Diverse African and Asian Settings: A Mixed Methods Socio-Behavioural Study

Autor: Paola, Castillo, Miguel J, Martínez, Esperança, Ussene, Dercio, Jordao, Lucilia, Lovane, Mamudo R, Ismail, Carla, Carrilho, Cesaltina, Lorenzoni, Fabiola, Fernandes, Rosa, Bene, Antonio, Palhares, Luiz, Ferreira, Marcus, Lacerda, Inacio, Mandomando, Jordi, Vila, Juan Carlos, Hurtado, Khátia, Munguambe, Maria, Maixenchs, Ariadna, Sanz, Llorenç, Quintó, Eusebio, Macete, Pedro, Alonso, Quique, Bassat, Clara, Menéndez, Jaume, Ordi
Rok vydání: 2016
Předmět:
Zdroj: PLoS Medicine
ISSN: 1549-1676
Popis: Background There is an urgent need to identify tools able to provide reliable information on the cause of death in low-income regions, since current methods (verbal autopsy, clinical records, and complete autopsies) are either inaccurate, not feasible, or poorly accepted. We aimed to compare the performance of a standardized minimally invasive autopsy (MIA) approach with that of the gold standard, the complete diagnostic autopsy (CDA), in a series of adults who died at Maputo Central Hospital in Mozambique. Methods and Findings In this observational study, coupled MIAs and CDAs were performed in 112 deceased patients. The MIA analyses were done blindly, without knowledge of the clinical data or the results of the CDA. We compared the MIA diagnosis with the CDA diagnosis of cause of death. CDA diagnoses comprised infectious diseases (80; 71.4%), malignant tumors (16; 14.3%), and other diseases, including non-infectious cardiovascular, gastrointestinal, kidney, and lung diseases (16; 14.3%). A MIA diagnosis was obtained in 100/112 (89.2%) cases. The overall concordance between the MIA diagnosis and CDA diagnosis was 75.9% (85/112). The concordance was higher for infectious diseases and malignant tumors (63/80 [78.8%] and 13/16 [81.3%], respectively) than for other diseases (9/16; 56.2%). The specific microorganisms causing death were identified in the MIA in 62/74 (83.8%) of the infectious disease deaths with a recognized cause. The main limitation of the analysis is that both the MIA and the CDA include some degree of expert subjective interpretation. Conclusions A simple MIA procedure can identify the cause of death in many adult deaths in Mozambique. This tool could have a major role in improving the understanding and surveillance of causes of death in areas where infectious diseases are a common cause of mortality.
Jaume Ordi and colleagues examine the validity of a standardized minimally invasive autopsy approach by comparison with that of the complete diagnostic autopsy in a series of adults who died at Maputo Central Hospital in Mozambique.
Author Summary Why Was This Study Done? While complete autopsies are considered the gold standard for the determination of cause of death, they are poorly accepted and difficult to perform in middle- and low-income countries. More feasible options, such as verbal autopsies and clinical records, are highly inaccurate. Minimally invasive autopsy techniques have been proposed as a more acceptable alternative to complete autopsy, and the results of these techniques have been shown to be relatively accurate; however, current minimally invasive autopsy protocols generally involve high-tech imaging procedures not available in middle- and low-income settings. Our study was designed to develop a simplified minimally invasive autopsy method that would be feasible in middle- and low-income countries, and to validate this method against the gold standard. What Did the Researchers Do and Find? The minimally invasive autopsy developed in this study consists of the collection of blood and cerebrospinal fluid samples and the collection of tissue samples from solid organs using biopsy needles, followed by histological and microbiological analyses. Coupled minimally invasive and complete autopsies were performed in 112 deceased patients. The samples obtained by both techniques were evaluated independently. Concordance between the putative diagnosis obtained with the minimally invasive autopsy and the gold standard diagnosis obtained by complete autopsy was 75.9%. The agreement was particularly high for infectious diseases. Moreover, the specific microorganisms causing death were accurately identified in the minimally invasive autopsy samples. What Do These Findings Mean? Minimally invasive autopsy is a reliable tool that can improve our understanding of the causes of death in Mozambique, where infectious diseases are a common cause of mortality. The use of this tool could improve health planning and priority setting for the most vulnerable populations in the world.
Databáze: OpenAIRE
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