Are non-invasive or minimally invasive autopsy techniques for detecting cause of death in prenates, neonates and infants accurate? A systematic review of diagnostic test accuracy

Abstract

ObjectivesTo assess the diagnostic accuracy of non-invasive or minimally invasive autopsy techniques in deaths under 1 year of age.DesignThis is a systematic review of diagnostic test accuracy. The protocol is registered on PROSPERO.ParticipantsDeaths from conception to one adjusted year of age.Search methodsMEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), the Cochrane Library, Scopus and grey literature sources were searched from inception to November 2021.Diagnostic testsNon-invasive or minimally invasive diagnostic tests as an alternative to traditional autopsy.Data collection and analysisStudies were included if participants were under one adjusted year of age, with index tests conducted prior to the reference standard.Data were extracted from eligible studies using piloted forms. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2. A narrative synthesis was conducted following the Synthesis without Meta-Analysis guidelines. Vote counting was used to assess the direction of effect.Main outcome measuresDirection of effect was expressed as percentage of patients per study.FindingsWe included 54 direct evidence studies (68 articles/trials), encompassing 3268 cases and eight index tests. The direction of effect was positive for postmortem ultrasound and antenatal echography, although with varying levels of success. Conversely, the direction of effect was against virtual autopsy. For the remaining tests, the direction of effect was inconclusive.A further 134 indirect evidence studies (135 articles/trials) were included, encompassing 6242 perinatal cases. The addition of these results had minimal impact on the direct findings yet did reveal other techniques, which may be favourable alternatives to autopsy.Seven trial registrations were included but yielded no results.ConclusionsCurrent evidence is insufficient to make firm conclusions about the generalised use of non-invasive or minimally invasive autopsy techniques in relation to all perinatal population groups.PROSPERO registration numberCRD42021223254.

Investigation of text‐mining methodologies to aid the construction of search strategies in systematic reviews of diagnostic test accuracy—a case study

“…Despite the original search strategy being designed by an information specialist with good knowledge of the topic, the tools were able to suggest terms which had otherwise been overlooked. The inclusion of these terms had varying degrees of success when attempting to find additional literature that was relevant to the DTA review 16,19 . Additional relevant records were found in many cases, however, the benefit of retrieving these needs to be weighed against the resources required to screen the volume of additional literature, most of which was not relevant to the DTA review (Figure 1).…”

“…The information specialist (HO) who designed the original search strategy used in this case study was already knowledgeable about the topic of the DTA review. 4 , 16 , 19 The original search was already extensive, covering many of the terms that would have otherwise been identified using these tools. Perhaps the use of these tools may be of more benefit when the information specialist is less familiar with the topic.…”

“…The aim of the DTA review was to determine whether non‐invasive or minimally invasive autopsy techniques would be suitable alternatives to traditional autopsy in prenatal and infant death prior to one year of life. 16 , 19 The review accepted any study design with a sequential element, assessing the less invasive techniques against the traditional techniques. 4 , 16 , 19 …”

“…16 , 19 The review accepted any study design with a sequential element, assessing the less invasive techniques against the traditional techniques. 4 , 16 , 19 …”

Does paraspinal muscle morphometry predict functional status and re-operation after lumbar spinal surgery? A systematic review and meta-analysis

“…When the meta-analysis was inappropriate due to the lack of metrics reported in < 3 studies, a vote-counting model was conducted according to previous studies, with the direction of effect [30][31][32]. The model followed the Cochrane and Synthesis without meta-analysis (SWiM) reporting guidelines [33,34].…”