ABSTRACT
The magnitude of the diagnostic benefit conferred by performing histopathological examinations after medico-legal/forensic autopsies remains debatable. We have tried to address this issue by reviewing a series of histopathology referrals concerning medico-legal autopsies in real-world routine practice. We present an audit of the consultations provided to forensics by clinical pathologists at our institute between 2015 and 2018. Over this period, 493 post-mortem examinations were performed by forensic pathologists. Of these cases, 52 (11%) were referred for histopathology. Gross assessment was requested in 22/52 (42%) cases. Histopathology examination was performed on single organs in 15/52 (29%) cases, primarily on the lung and heart, whereas parenchymatous multi-organ analysis was carried out in 14/52 (27%) cases. Bone-marrow sampling was studied in 4/52 (8%) cases. Immunohistochemistry was needed in 16/52 (31%) cases, special stains in 9/52 (21%) cases and molecular analysis in 4/52 (8%) cases. Focusing on technical processes, standard methodology on pre-analytical procedures was changed in 10/52 (19%) cases in order to answer specific diagnostic questions. We showed that although most of the time the diagnosis is clear by the end of dissection on the basis of the macroscopic findings, histopathology can provide, modify or confirm the cause of death in many medico-legal/forensic cases. Therefore, it is desirable that forensic pathologists and clinical pathologists establish robust working relationships in a cooperative environment. We conclude that it is important to implement guidelines based on real-world routine practice in order to identify cases where histopathology can provide useful contributions, which in our experience applied to 11% of forensic cases.
Subject(s)
Autopsy , Forensic Pathology/methods , Pathology, Clinical/methods , Referral and Consultation , Guidelines as Topic , Humans , Pathologists/classification , Pathologists/standardsABSTRACT
Antecedentes: la Apendicitis Aguda (A.A) es una urgencia quirúrgica que requiere un diagnóstico y tratamiento oportuno. Muchas veces puede ser un gran reto para el cirujano por su relación con otras patologías, de allí la importancia de precisar su diagnóstico. Objetivo: validar la precisión diagnóstica del score RIPASA en apendicitis aguda comparándolo con el examen histopatológico. Metodología: se realizó un estudio de validación de pruebas diagnósticas con la información de 300 historias clínicas de pacientes apendicectomizados, atendidos en el Hospital Vicente Corral Moscoso durante el año 2018. Se evaluó mediante el score RIPASA al ingreso y se comparó con los resultados de histopatología como prueba gold standar. Se calculó la sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, además se obtuvo Odds Ratio con su IC al 95% para establecer la validez predictiva de esta escala. Resultados: la media de edad fue de 32 años ± 13,7 (DS), más de la mitad fueron: sexo femenino 52%, área urbana 74.7% y bachillerato 62.7%, predominó la etnia mestiza 99.7%. Hubo una asociación de riesgo entre una alta probabilidad de apendicitis según el score RIPASA con A.A (OR 96,36; IC95%: 16,03578,68; p= 0,000). El score RIPASA tiene una sensibilidad de 98.97%, especificidad 50.0%, VPP 98.63%, VPN 57,14%, RVP 1.98% Y RVN 0.2%. Conclusiones: RIPASA tiene alta probabilidad para detectar a personas con apendicitis aguda, pero no así a las sanas, por lo cual se requiere continuar con más estudios para establecer tal validez
Background: Acute Appendicitis (A.A) is a surgical emergency that requires timely diagnosis and treatment. Many times it can be a great challenge for the surgeon because of its relationship with other pathologies, hence the importance of specifying its diagnosis. Objective: To validate the diagnostic accuracy of the RIPASA score in acute appendicitis by comparing it with the histopathological examination. Methodology: A study of validation of diagnostic tests was carried out with the information of 300 medical records of appendectomized patients, treated at the Vicente Corral Moscoso Hospital during 2018. It was evaluated by means of the RIPASA score at admission and compared with the histopathology results. as gold standard test. Sensitivity, specificity, positive predictive value, negative predictive value were calculated, in addition Odds Ratio was obtained with its 95% CI to establish the predictive validity of this scale. Results: The mean age was 32 years ± 13.7 (SD), more than half were: female 52%, urban area 74.7% and high school 62.7%, mixed race ethnicity predominated 99.7%. There was a risk association between a high probability of appendicitis according to the RIPASA score with A.A (OR 96.36; 95% CI: 16.03578.68; p = 0.000). The RIPASA score has a sensitivity of 98.97%, specificity 50.0%, PPV 98.63%, NPV 57.14%, RVP 1.8% and RVN 0.2% Conclusions: RIPASA has a high probability of detecting people with acute appendicitis, but not healthy ones, so it is necessary to continue with more studies to find such validity
