Clinico-pathological discrepancies in the diagnosis of causes of death in adults in Mozambique: a retrospective observational study
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- dc.contributor.author Ordi, Jaume
- dc.contributor.author Letang Jiménez de Anta, Emilio Ángel
- dc.contributor.author Menéndez, Clara
- dc.date.accessioned 2020-03-30T06:27:40Z
- dc.date.available 2020-03-30T06:27:40Z
- dc.date.issued 2019
- dc.description.abstract 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.
- dc.format.mimetype application/pdf
- dc.identifier.citation Ordi J, Castillo P, Garcia-Basteiro AL, Moraleda C, Fernandes F, Quintó L, et al. Clinico-pathological discrepancies in the diagnosis of causes of death in adults in Mozambique: a retrospective observational study. PLoS One. 2019 Sep 6; 14(9):e0220657. DOI: 10.1371/journal.pone.0220657
- dc.identifier.doi http://dx.doi.org/10.1371/journal.pone.0220657
- dc.identifier.issn 1932-6203
- dc.identifier.uri http://hdl.handle.net/10230/44086
- dc.language.iso eng
- dc.publisher Public Library of Science (PLoS)
- dc.rights © 2019 Ordi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, https://creativecommons.org/licenses/by/4.0/ which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri https://creativecommons.org/licenses/by/4.0/
- dc.subject.other Salut pública -- Moçambic
- dc.subject.other Malalties -- Moçambic
- dc.subject.other Moçambic -- Mortalitat
- dc.title Clinico-pathological discrepancies in the diagnosis of causes of death in adults in Mozambique: a retrospective observational study
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion