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Table 3 Examples of gold standard criteria for adult breast cancer, adult acute myocardial infarction, child pneumonia, and neonatal birth asphyxia

From: Population Health Metrics Research Consortium gold standard verbal autopsy validation study: design, implementation, and development of analysis datasets

Adult breast cancer
Level 1 One of the following:
     • Operative specimen with histological confirmation
     • Biopsy/fine needle aspiration cytology
Level 2A Both of the following:
     • Mammography diagnosis
     • Imaging evidence of metastases in bone, lung, etc. based on CT scan/MRI/X-rays
Level 2B Patient under treatment from a recognized cancer hospital or cancer unit for breast cancer in cases where the basis for the initial diagnosis is no longer available.
Adult acute myocardial infarction
Level 1 Evidence of acute MI within three months preceding death based upon one or more of the following:
     • Cardiac perfusion scan
     • ECG changes
     • Documented history of CABG or PTCA or stenting
     • Coronary angiography
     • Enzyme changes (any troponin elevation or CK-MB isoenzyme elevation >2 times the upper limit of normal) in the context of myocardial ischemia
Level 2A Clinical evidence of the following:
     • Sudden death within six hours of the onset of characteristic shock and chest pain when the case has been witnessed by a physician
Child pneumonia
Level 1 Chest X-ray showing primary end-point consolidation, pleural effusion or other consolidation/infiltration, plus two or more of the following:
     • Respiratory rate >70/minute
     • Severe lower chest indrawing
     • Abnormal breath sounds (i.e., grunting, decreased breath sounds, crepitations)
     • Rectal temperature >38°C or <36°C
     • Oral or axillary temperature >37.5°C or <35.5°C
Neonatal birth asphyxia
Level 1 Each of the following:
     • Failure both to breathe spontaneously and to cry at birth
     • No major congenital abnormality
     • Not a stillbirth (one or more signs of life at birth like pulse or movement)
  Plus one of the following in the 24 hours after birth:
     • Not feeding
     • Hypotonia
     • Seizures
     • Needed and failed resuscitation at birth
  1. Level 1 is the most stringent criteria, while level 2A or 2B were also collected for some causes.