1. Clinicopathological discrepancies in the diagnoses of childhood causes of death in the CHAMPS network: An analysis of antemortem diagnostic inaccuracies
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Khatia Munguambe, Quique Bassat, Robert F Breiman, Mahbubur Rahman, Sibone Mocumbi, Cynthia G Whitney, Amy Wise, Shams El Arifeen, Meerjady Sabrina Flora, Soter Ameh, Emily S Gurley, Mustafizur Rahman, Ariel Nhacolo, Carla Carrilho, Cheick Bougadari Traore, Lucy Liu, Inacio Mandomando, Clara Menendez, Chris A Rees, Janet Agaya, Jane Juma, Tadesse Gure, George Aol, Hennie Lombaard, Ziyaad Dangor, Shabir Madhi, James Bunn, Samba O Sow, Dickson Gethi, Sanwarul Bari, Jeffrey P Koplan, Natalia Rakislova, Fabiola Fernandes, Tacilta Nhampossa, Maria Maixenchs, Mohammed Kamal, Nega Assefa, Joseph Oundo, Lola Madrid, Tahmina Shirin, Nelesh P Govender, Addisu Alemu, Hailemariam Legesse, Uma U Onwuchekwa, Awa Traore, Portia C Mutevedzi, Victor Akelo, Sammy Khagayi, Dickens Onyango, Richard Omore, Yasmin Adam, Peter Otieno, Margaret Mannah, Vicky Baillie, Karen L Kotloff, John Blevins, Milagritos D Tapia, Rima Koka, Mohammad Zahid Hossain, Dickens Kowuor, Tom Sesay, James Squire, Francis Moses, Haleluya Leulseged, Christine Bethencourt, Kitiezo Aggrey Igunza, Ikechukwu U Ogbuanu, Andrew Moseray, Ima-Abasi Bassey, Afruna Rahman, Muntasir Alam, Yasir Y Abdullahi, Nana Kourouma, Seydou Sissoko, Rosauro Varo, Sana Mahtab, Martin Hale, Jeanie du Toit, Zachary J Madewell, Dianna M Blau, Roosecelis B Martines, Fatima Solomon, Gillian Sorour, Jeannette Wadula, Karen Petersen, Peter J Swart, Sanjay G Lala, Sithembiso Velaphi, Richard Chawana, Ashleigh Fritz, Nellie Myburgh, Pedzisai Ndagurwa, Cleopas Hwinya, Shahana Parveen, ASM Nawshad Uddin Ahmed, Mahbubul Hoque, Saria Tasnim, Ferdousi Islam, Farida Ariuman, Mohammad Mosiur Rahman, Ferdousi Begum K Zaman, Dilruba Ahmed, Alexander M Ibrahim, Fikremelekot Temesgen, Melisachew Mulatu Yeshi, Mahlet Abayneh Gizaw, Stian MS Orlien, Solomon Ali, Peter Nyamthimba Onyango, Richard Oliech, Joyce Akinyi Were, Thomas Misore, Harun Owuor, Christopher Muga, Bernard Oluoch, Christine Ochola, Sharon M Tennant, Carol L Greene, Ashka Mehta, J Kristie Johnson, Brigitte Gaume, Adama Mamby Keita, Karen D Fairchild, Diakaridia Kone, Diakaridia Sidibe, Doh Sanogo, Kounandji Diarra, Tiéman Diarra, Kiranpreet Chawla, Zara Manhique, Fatmata Bintu Tarawally, Martin Seppeh, Ronald Mash, Julius Ojulong, Babatunde Duduyemi, Alim Swaray-Deen, Joseph Bangura Amara Jambai, Okokon Ita, Cornell Chukwuegbo, Sulaiman Sannoh, Princewill Nwajiobi, Erick Kaluma, Oluseyi Balogun, Carrie Jo Cain, Solomon Samura, Samuel Pratt, Joseph Kamanda Sesay, Osman Kaykay, Binyam Halu, Francis Smart, Sartie Kenneh, Jana Ritter, Tais Wilson, Jonas Winchell, Jakob Witherbee, Navit T Salzberg, Margaret Basket, Ashutosh Wadhwa, Kyu Han Lee, Roosecelis Martines, Shamta Warang, Maureen Diaz, Jessica Waller, Shailesh Nair, Courtney Bursuc, Kristin LaHatte, Sarah Raymer, Solveig Argeseanu, Kurt Vyas, and Manu Bhandari
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Pediatrics ,RJ1-570 - Abstract
Introduction Determining aetiology of severe illness can be difficult, especially in settings with limited diagnostic resources, yet critical for providing life-saving care. Our objective was to describe the accuracy of antemortem clinical diagnoses in young children in high-mortality settings, compared with results of specific postmortem diagnoses obtained from Child Health and Mortality Prevention Surveillance (CHAMPS).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.
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- 2024
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