15283-B-Blokker

89 Agreement between MIA and CA: a cross-sectional study 5 Recent studies investigated the additional value of post-mortem CT angiography (PMCTA), achieving an accuracy of 80% for cardiac causes of death. 134 In a selected group of 50 cases Wichmann et al. 80 compared diagnoses (not COD) identified by PMCTA or CA. They found 16 new major diagnoses, comparable to GMD in our study, 93.8% of these were identified by PMCTA and 87.5% by CA. These figures are comparable to the clinically unsuspected GMD in our study. Most recently, in a less biased population, Rutty et al. 133 established a correct COD in 92% of cases using PMCTA relative to consensus COD, as in our study. Bolliger et al. 109 and Ross et al. 108 combined PMCT, PMCTA and biopsies. In our systematic review, 56 we calculated for these studies a pooled sensitivity for COD of 90.9% (95%CI: 74.5-97.6). The performance of MIA in our study is even higher with 97.0% of COD correctly identified. MIA, apart from being minimally invasive, has other advantages over CA: it provides a permanent auditable record of the entire body including the brain that can be consulted repeatedly, objectively, and at any location by pathologists, radiologists, clinicians, scientists, and next - of - kin. It is therefore potentially a more powerful tool than CA for quality control in healthcare and a more dependable resource for health statistics, epidemiology and biomedical research. 56,95,102 In addition, MIA is suitable for providing biomedical research with pathologically changed tissues, which would otherwise be hard to ascertain, such as metastatic tumor tissue from patients who died of cancer for whom consent for autopsy is often difficult to obtain. 26,143 In the future, a robotic system may enable automated needle placement to shorten the procedure time. 96 MIA and CA appear to have their own strengths and weaknesses, 56 and future post- mortem examination will probably utilize combinations of the two approaches, such as MIA followed by a partial autopsy, and CA preceded by imaging. In the latter scenario CA could be omitted if COD is established by imaging. 102,136 In summary, there was a high agreement between MIA and CA as to COD; and importantly MIA resulted in a higher yield of diagnoses. Seventeen percent of COD and 43% of GMD was clinically not suspected, illustrating the lasting importance of post-mortem examination for quality control in healthcare. Further studies into acceptance of MIA by next-of-kin and clinicians have to show whether introduction of MIA will indeed increase autopsy rates, and strengthen its role in healthcare quality control. In an individual case for which a clinician desires an autopsy, including the brain, for clinical or scientific reasons, he may be able to get consent for MIA from next-of-kin refusing CA.