Diagnostic accuracy of physician review, expert algorithms and data-derived algorithms in adult verbal autopsies

Background The verbal autopsy (VA) is used to collect information on cause- specific mortality from bereaved relatives. A cause of death may be assigne d by physician review of the questionnaires, or by an algorithm. We compare d the diagnostic accuracy of physician review, an expert algorithm, and dat a-derived algorithms. Methods Data were drawn from a multicentre validation study of 796 adult de aths that occurred in hospitals in Tanzania, Ethiopia, and Ghana. A 'gold s tandard' cause of death was assigned using hospital records and death certi ficates. The VA interviews were carried out by trained fieldworkers 1-21 mo nths after the subject's death. A cause of death was assigned by physician review and an expert algorithm. Data-derived algorithms that most accuratel y estimated the cause-specific mortality fraction (CSMF) for each cause of death were identified using logistic regression. Results The most common causes of death were tuberculosis/AIDS (CSMF = 18.6 %), malaria (CSMF = 10.7%), meningitis (CSMF = 8.3%), and cardiovascular di sorders (CSMF = 8.2%). The CSMF obtained using physician review was within +/-20% of the gold standard value for 12 causes of death including the four common causes. The CSMF obtained using the expert algorithm was within +/- 20% of the gold standard for eight causes of death, including tuberculosis/ AIDS, malaria, and meningitis. The CSMF obtained using the data-derived alg orithms was within +/-20% of the gold standard for seven causes of death, i ncluding tuberculosis/AIDS, meningitis, and cardiovascular disorders. All t hree methods yielded a specificity of at least 80% for all causes of death, and a sensitivity of at least 80% for deaths due to injuries and rabies. Conclusions For those settings where physician review is not feasible, expe rt and data-derived algorithms provide an alternative approach for assignin g many causes of death. We recommend that the algorithms proposed herein ar e validated further.