title: Simplified Symptom Pattern Method for verbal autopsy analysis: multisite validation study using clinical diagnostic gold standards.
abstract: BACKGROUND
  Verbal autopsy can be a useful tool for generating cause of death data in data-sparse regions around the world. The Symptom Pattern (SP) Method is one promising approach to analyzing verbal autopsy data, but it has not been tested rigorously with gold standard diagnostic criteria. We propose a simplified version of SP and evaluate its performance using verbal autopsy data with accompanying true cause of death.
  
  
  METHODS
  We investigated specific parameters in SP's Bayesian framework that allow for its optimal performance in both assigning individual cause of death and in determining cause-specific mortality fractions. We evaluated these outcomes of the method separately for adult, child, and neonatal verbal autopsies in 500 different population constructs of verbal autopsy data to analyze its ability in various settings.
  
  
  RESULTS
  We determined that a modified, simpler version of Symptom Pattern (termed Simplified Symptom Pattern, or SSP) performs better than the previously-developed approach. Across 500 samples of verbal autopsy testing data, SSP achieves a median cause-specific mortality fraction accuracy of 0.710 for adults, 0.739 for children, and 0.751 for neonates. In individual cause of death assignment in the same testing environment, SSP achieves 45.8% chance-corrected concordance for adults, 51.5% for children, and 32.5% for neonates.
  
  
  CONCLUSIONS
  The Simplified Symptom Pattern Method for verbal autopsy can yield reliable and reasonably accurate results for both individual cause of death assignment and for determining cause-specific mortality fractions. The method demonstrates that verbal autopsies coupled with SSP can be a useful tool for analyzing mortality patterns and determining individual cause of death from verbal autopsy data.
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Ave,, Suite 600, Seattle, WA 98121, USA. cjlm@uw.edu.
authors.forename: Christopher Jl
authors.initials: CJ
authors.lastname: Murray
authors.forename: Spencer L
authors.initials: SL
authors.lastname: James
authors.forename: Jeanette K
authors.initials: JK
authors.lastname: Birnbaum
authors.forename: Michael K
authors.initials: MK
authors.lastname: Freeman
authors.forename: Rafael
authors.initials: R
authors.lastname: Lozano
authors.forename: Alan D
authors.initials: AD
authors.lastname: Lopez