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

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