15283-B-Blokker

85 Agreement between MIA and CA: a cross-sectional study 5 At MIA 1574 biopsies were obtained, targeting 655 organs/tissues: 78.5% (1236/1574) from heart, lungs, liver, kidney and spleen; 21.5% (338/1574) from other organs/ tissues, for suspected pathology upon imaging. Twenty cases underwent both stereotactic biopsies and brain autopsy; four had biopsies only; 18 brain autopsy only. In 22 cases cytological samples were obtained at MIA: 17 routinely from cerebrospinal fluid; five from pathological fluid collections. (Appendix G) Agreement on COD MIA and CA agreed on COD in 91 cases (Table 1-A), including one case in which a certain cause of death was established with neither MIA nor CA. Out of the eight discordant cases, MIA diagnosed the consensus COD in five, and CA in three (Table 1-B), resulting in a correct COD in 96 MIA cases and in 94 CA cases (P=0.727). The performance of imaging (PMCT and PMMR) alone in establishing COD is shown in Table 2. In 11 MIA a certain COD could have been established without the need for biopsy, because of an unequivocal COD at imaging: Tension pneumothorax, massive air embolus (Figure 1), type - A aorta dissection, esophago - pleural fistula, ruptured aneurysm of abdominal aorta, rebleed of cerebral arteriovenous malformation, acute subdural and intracerebral hemorrhages with compression and cerebral ischemia. Clinical Correlation In 65 cases the clinically presumed COD was the same as the consensus COD found by MIA and/or CA. In an additional 17 the consensus COD was mentioned in the clinical differential diagnosis, leaving another 17 cases in which the COD was not suspected clinically. The latter were: pneumonia (N=5); myocardial infarction (N=2); type A aorta dissection (N=2); tension pneumothorax, massive air embolus, multiple organ failure, acute cellular (A2) lung rejection, mesenteric ischemia, sepsis, disseminated intravascular coagulation, and subdural hematoma (N=1). Three of the 17 clinically unsuspected COD were only found by MIA (tension pneumothorax; massive air embolus; Type A dissection); two only by CA (severe coronary atherosclerosis causing acute coronary syndrome; mesenteric ischemia). In 86 cases 219 additional specific clinical questions were asked. MIA and CA answered respectively 189 (86.3%) and 182 (83.1%) of them (p=0.353). Typically, questions regarding pathological changes not visible or not recognized on imaging, and therefore not biopsied, were not answered with MIA.