Kalter H D, Gray R H, Black R E, Gultiano S A
Department of Population Dynamics, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland 21205.
Int J Epidemiol. 1990 Jun;19(2):380-6. doi: 10.1093/ije/19.2.380.
In developing countries, diagnoses of diseases associated with deaths in children are frequently derived from retrospective maternal interviews. To determine the validity of this methodology, and to define sensitive and specific diagnostic algorithms, we compared symptoms and signs reported by mothers using structured questionnaires, with selected physician diagnoses for 164 deaths among hospitalized children on the Philippine island of Cebu. The 164 decreased children had 256 physician diagnoses of acute lower respiratory infections (ALRI) (100), diarrhoeas (92), measles (48), and neonatal tetanus cases (16). Forty-three per cent of children had multiple illnesses. An algorithm for tetanus (age at death less than or equal to 30 days with convulsion or spasm) was 100% sensitive, but specificity could not be estimated due to the small number of comparison neonatal deaths. An algorithm for measles (age greater than or equal to 120 days, with rash and fever for at least three days) had 98% sensitivity and 90% specificity. Diagnosis of ALRI was more difficult, cough and dyspnoea alone yielding 86% sensitivity but low specificity, whereas prolonged cough and dyspnoea provided 93% specificity but low sensitivity (41%). Diarrhoea diagnoses based on frequent loose or liquid stools had high sensitivity (78-84%) and specificity (79%), irrespective of whether the child died with diarrhoea alone or in combination with other illnesses. However, maternal reports of moderate/severe dehydration had low specificity. We conclude that, in this setting, verbal autopsies can diagnose major illnesses contributing to death in children with acceptable sensitivity and specificity.
在发展中国家，与儿童死亡相关疾病的诊断常常源自对母亲的回顾性访谈。为确定这种方法的有效性，并定义敏感且特异的诊断算法，我们将母亲使用结构化问卷报告的症状和体征，与菲律宾宿务岛住院儿童中164例死亡病例的选定医生诊断结果进行了比较。这164名死亡儿童有256次医生诊断，包括急性下呼吸道感染（ALRI）（100例）、腹泻（92例）、麻疹（48例）和新生儿破伤风病例（16例）。43%的儿童患有多种疾病。一种破伤风诊断算法（死亡年龄小于或等于30天且伴有惊厥或痉挛）敏感性为100%，但由于用于比较的新生儿死亡病例数量少，无法估计其特异性。一种麻疹诊断算法（年龄大于或等于120天，伴有皮疹和发热至少三天）敏感性为98%，特异性为90%。ALRI的诊断更困难，仅咳嗽和呼吸困难的敏感性为86%，但特异性低，而持续性咳嗽和呼吸困难的特异性为93%，但敏感性低（41%）。基于频繁稀便或水样便的腹泻诊断具有较高的敏感性（78 - 84%）和特异性（79%），无论儿童是单独死于腹泻还是与其他疾病合并。然而，母亲报告的中度/重度脱水特异性较低。我们得出结论，在这种情况下，口头尸检能够以可接受的敏感性和特异性诊断导致儿童死亡的主要疾病。
