15283-B-Blokker

57 Alternatives to conventional autopsy: a systematic review 4 data points per table and these differences could easily be resolved. A third reviewer was consulted for advice on structuring the data extraction tables. Per article the reviewers extracted data on study population, number of cases eligible for this review, study design/ methods, cost of the methods, and, if possible, data for outcomes in 2x2 tables. From these 2x2 tables on cause of death and/or (overall, major and/or minor) diagnostic findings both reviewers independently calculated the percentage of agreement, the sensitivity and if possible the specificity. If they were not able to extract any false positives and/ or true negatives, the reviewers only calculated sensitivity. If the reviewers could not extract any data from the original article for a 2x2 table, the reported outcome measures were quoted. If necessary the reviewers contacted the authors, requesting additional information in order to exclude individual cases (based on age or suspected forensic cause of death) in the articles, 102-107 or to identify multiple reports of the same cases. 105,106,108,109 Unfortunately, only one author responded. 104 The alternative autopsy methods applied and the case characteristics in the included studies were very heterogeneous, precluding meaningful meta-analysis of the study outcomes. The outcomes of only two studies were pooled, since these studies seemed to be performed by the same research group, investigating the same alternative autopsy method, and even including some of the same cases. 108,109 RESULTS All database searches together provided us with 1538 articles that matched the search criteria (see figure 1), of which 51 were considered potentially relevant (see appendix 2). One of these articles could not be obtained via our hospital library. Of the remaining 50 articles 34 were not eligible for this systematic review upon reading the full text. Study design and quality appraisal Sixteen articles, published from 1996 to 2014, met the five inclusion criteria (see tables 1-3). Eight studies included just cases of adult deaths, 57,59,80,102,110-113 and in seven studies the cases were only included if the cause of death was suspected to be natural. 57,104,107 ,109-111,114 Among the studies that registered a male-female ratio, the majority of cases was male. The available mean ages differed from 22.7 years to 74.0 years.