Clinicopathological discrepancies in the diagnoses of childhood causes of death in the CHAMPS network: An analysis of antemortem diagnostic inaccuracies.
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Ошибки и ограничения
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Leulseged Haleluya, Bethencourt Christine, Igunza Kitiezo Aggrey, Akelo Victor, Onyango Dickens, Omore Richard, Ogbuanu Ikechukwu U, Ameh Soter, Moseray Andrew, Kowuor Dickens, Bassey Ima-Abasi, El Arifeen Shams, Gurley Emily S, Hossain Mohammad Zahid, Rahman Afruna, Alam Muntasir, Assefa Nega, Madrid Lola, Alemu Addisu, Abdullahi Yasir Y, Kotloff Karen L, Sow Samba O, Tapia Milagritos D, Kourouma Nana, Sissoko Seydou, Bassat Quique, Varo Rosauro, Mandomando Inacio, Carrilho Carla, Rakislova Natalia, Fernandes Fabiola, Madhi Shabir, Dangor Ziyaad, Mahtab Sana, Hale Martin, Baillie Vicky, du Toit Jeanie, Madewell Zachary J, Blau Dianna M, Martines Roosecelis B, Mutevedzi Portia C, Breiman Robert F, Whitney Cynthia G, Rees Chris A, Child Health and Mortality Prevention Surveillance (CHAMPS) network
Аннотация
METHODS: We analysed data collected during 2016-2022 from seven sites in Africa and South Asia. We compared antemortem clinical diagnoses from clinical records to a reference standard of postmortem diagnoses determined by expert panels at each site who reviewed the results of histopathological and microbiological testing of tissue, blood, and cerebrospinal fluid. We calculated test characteristics and 95% CIs of antemortem clinical diagnostic accuracy for the 10 most common causes of death. We classified diagnostic discrepancies as major and minor, per Goldman criteria later modified by Battle.
RESULTS: CHAMPS enrolled 1454 deceased young children aged 1-59 months during the study period; 881 had available clinical records and were analysed. The median age at death was 11 months (IQR 4-21 months) and 47.3% (n=417) were female. We identified a clinicopathological discrepancy in 39.5% (n=348) of deaths; 82.3% of diagnostic errors were major. The sensitivity of clinician antemortem diagnosis ranged from 26% (95% CI 14.6% to 40.3%) for non-infectious respiratory diseases (eg, aspiration pneumonia, interstitial lung disease, etc) to 82.2% (95% CI 72.7% to 89.5%) for diarrhoeal diseases. Antemortem clinical diagnostic specificity ranged from 75.2% (95% CI 72.1% to 78.2%) for diarrhoeal diseases to 99.0% (95% CI 98.1% to 99.6%) for HIV.
CONCLUSIONS: Antemortem clinical diagnostic errors were common for young children who died in areas with high childhood mortality rates. To further reduce childhood mortality in resource-limited settings, there is an urgent need to improve antemortem diagnostic capability through advances in the availability of diagnostic testing and clinical skills.