Validating a Minimally Invasive Tissue Sampling (MITS) Method in Determining Cause of Death in Stillbirths and Neonates

Abstract

Complete diagnostic autopsy (CDA) remains the gold standard and a valuable technique for determining cause of death. It is a source of health statistics that can be used to measure health care services’ quality, unraveling important information on disease processes, particularly in emerging and unknown diseases. It can also be a vital tool for medical education and biomedical research. However, autopsy rates have been declining globally. There is an urgent need to develop and validate alternative methods in different settings to provide reliable information on cause of death. In this study, we aimed to determine cause of death (KazCoDe) in neonates and infants using minimally invasive tissue sampling (MITS), and to compare these results with those of CDA. We conducted MITS and CDA sequentially on 24 deceased children at the Pathological Bureau of the Akimat of the city of Nur-Sultan. Clinical data of the study subjects were extracted from their clinical records. During both procedures, brain, liver and lung tissues were collected for pathological diagnosis. Fifteen (62.5%) and nine (37.5%) were stillbirths and neonates, respectively. Eight (33.3%) were females and 16 (66.7%) were males. MITS diagnosis of cause of death was concordant with CDA diagnosis in 83.3% out of the 24 cases when considering the immediate and underlying causes of death and reviewing all the clinical and laboratory test results as part of the diagnostic evaluation to arrive at a cause of death (ICD-PM). We concluded that MITS is a valuable and reliable method for cause of death diagnosis in stillbirths and neonates, which can contribute vital mortality statistics in children in the absence of CDA.

Experience on postmortem minimally invasive tissue sampling to ascertain the cause of death determination in South African children: A case for implementing as standard of care

“…[12] Findings from Mozambique showed 83% correlation in the cause of death determination using MITS compared with complete diagnostic autopsy, including stillbirths, and in the absence of antemortem clinical data. [12][13][14] The Child Health and Mortality Prevention Surveillance (CHAMPS) programme is a multicentre surveillance across seven LMIC settings. CHAMPS aims to determine the causal pathway to death on the causes of stillbirths and under-5 childhood deaths.…”

Postmortem minimally invasive tissue sampling in communities: exploring perceptions of families, funeral workers, religious and community leaders and healthcare providers from Pakistan

“…. A recent study by Tanko et al reported MITS to be a valuable and reliable diagnostic procedure for the identification of CoD in children, stillbirth, and neonates which can be used to contribute vital mortality statistics if complete diagnostic autopsy is unavailable [ 8 ]. Importantly, MITS allows for the collection of tissue samples with minimal invasiveness, reducing disruption to the body of the deceased while enabling healthcare professionals to obtain accurate and reliable information [ 9 ].…”

The discrepancy of antemortem clinical diagnosis and postmortem autopsy diagnosis of lung pathologies in under-five deaths and the reasons for discrepancies: a case series analysis

“…Clinicopathologic discrepancy studies aim to evaluate the accuracy of clinical diagnoses by comparing them with the reference standard of postmortem autopsy diagnoses [10]. Despite advances in medical technology, signi cant discrepancies between antemortem clinical diagnoses and complete diagnostic autopsies (CDA) have been observed in as much as 45% of childhood deaths [11]. CDAs have long been considered the benchmark in establishing the cause of death (CoD).…”

“…CDA improves the identi cation of underlying causes and mechanisms of disease leading to death [8,11]. However, the resources and expertise required for CDAs are often lacking in developing countries like Ethiopia [12][13][14].…”