Post-mortem computed tomography in adult non-suspicious death investigation—evaluation of an NHS based service

Objective: Post-mortem CT (PMCT) can replace autopsy in many cases of non-suspicious death. A purely NHS-based service to replace autopsy with PMCT was launched, with the cost met by the family from 2015 to 2017, and subsequently “free at the point of delivery” after local authority funding was secured. The aim of the service was to improve the experience for the families. This report describes and evaluates the service against local standards of (1) less than four day turn around, (2) cause of death given in >90% and (3) less than 10% require autopsy. Methods: A retrospective review of reports, records and emails was undertaken to collate demographics, times of different stages of the process, the outcome and comments from service users. Results: Between July 2015 and July 2018, 279 patients had PMCT scans, 67 (24.0%) in the family-funded service and 212 (76%) in the current service. 97.1% (n = 271/279) of cases had the radiology report issued by day 3 (96.8% vs 98.6% for the family funded and local authority-funded services respectively). A cause of death was given in 97.2% of scans. 2.8% of patients required autopsy. Feedback from families, coroner’s officers and undertakers has been overwhelmingly positive. Conclusion: The services exceeded local standards and met the needs of the Coroner and the families based on the feedback received. This model could be employed for similar services, but the change to the logistics and financial structures required to initiate such services remains a significant hurdle. Advances in knowledge: This is the first report of a fully NHS-based PMCT service.

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Added value of post-mortem computed tomography (PMCT) to clinical findings for cause of death determination in adult “natural deaths”

International Journal of Legal Medicine ◽

10.1007/s00414-019-02219-6 ◽

2019 ◽

Vol 134 (4) ◽

pp. 1457-1463

Author(s):

M. E. M. Vester ◽

R. R. van Rijn ◽

W. L. J. M. Duijst ◽

L. F. M. Beenen ◽

M. Clerkx ◽

...

Keyword(s):

Computed Tomography ◽

Cause Of Death ◽

Medical Records ◽

Clinical Findings ◽

Added Value ◽

Post Mortem ◽

Additional Information ◽

Organ Failures ◽

Total Body ◽

Underlying Diseases

Abstract Purpose The aim of this study was to investigate whether post-mortem computed tomography (PMCT) provides additional information regarding the cause of death and underlying diseases in a general practitioners’ (GP), out-of-hospital population. Methods and materials Bodies donated to our anatomy department between January 2014 and January 2018, who consecutively underwent a total body PMCT and had given permission for retrieval of their medical records during life, were included. PMCT scans were assessed by a radiologist and compared with the cause of death as stated in the medical records. Discrepancies were analyzed with an adjusted Goldman classification. Results Ninety-three out of the 274 scanned donors during the inclusion period had given consent for the retrieval of their medical records, of which 79 GP’s responded to the request thereof (31 men, 48 women, average age 72.8 years, range 36–99). PMCT identified 49 (62%) cases of cancer, 10 (12.7%) cardiovascular diseases, 8 (10.1%) severe organ failures, 5 (6.3%) cases with signs of pneumonia, 2 (2.5%) other causes, and 7 (8.9%) cases without an (underlying) definitive cause of death. Eleven major discrepancies on the Goldman classification scale, with possible relevance to survival between PMCT and GP records, were identified. Conclusion PMCT can have added value for the detection of additional findings regarding the cause of death in an out-of-hospital, GP’s population, especially to identify or exclude major (previously non-diagnosed) underlying diseases.

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The Importance of Surgeon-reviewed Computed Tomography for Incisional Hernia Detection: A Prospective Study

The American Surgeon ◽

10.1177/000313481408000730 ◽

2014 ◽

Vol 80 (7) ◽

pp. 720-722 ◽

Cited By ~ 5

Author(s):

Rebeccah B. Baucom ◽

William C. Beck ◽

Michael D. Holzman ◽

Kenneth W. Sharp ◽

William H. Nealon ◽

...

Keyword(s):

Computed Tomography ◽

Incisional Hernia ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Radiology Report ◽

Incisional Hernias ◽

Radiology Reports ◽

Sensitivity Specificity ◽

A Prospective Study ◽

The Cost

Patients with incisional hernias or abdominal pain are frequently referred with abdominal computed tomography (CT) scans. The purpose of this study was to determine the sensitivity and specificity of a CT radiology report for the detection of incisional hernias. General surgery patients with a history of an abdominal operation and a recent viewable abdominal CT scan were enrolled prospectively. Patients with a stoma, fistula, or soft tissue infection were excluded. The results of the radiology reports were compared with blinded, surgeon-interpreted CT for each patient. Testing characteristics including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. One hundred eighty-one patients were enrolled with a mean age of 54 years. Sixty-eight per cent were women. Hernia prevalence was 55 per cent, and mean hernia width was 5.2 cm. The radiology report had a sensitivity and specificity of 79 per cent and 94 per cent, respectively, for hernia diagnosis. The PPV and NPV were 94 and 79 per cent, respectively. Reliance on the CT report alone underestimates the presence of incisional hernia. Referring physicians should not use CT as a screening modality for detection of hernias. Referral to a surgeon for evaluation before imaging may provide more accurate diagnosis and potentially decrease the cost of caring for this population.

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Identifying the correct cause of death: The role of post-mortem computed tomography in sudden unexplained death

Journal of Forensic Radiology and Imaging ◽

10.1016/j.jofri.2014.09.003 ◽

2014 ◽

Vol 2 (4) ◽

pp. 210-212

Author(s):

Matthew Clarke ◽

Angus McGregor ◽

Claire Robinson ◽

Jasmin Amoroso ◽

Bruno Morgan ◽

...

Keyword(s):

Computed Tomography ◽

Cause Of Death ◽

Post Mortem ◽

Sudden Unexplained Death ◽

Unexplained Death

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Post-mortem toxicological urine screening in cause of death determination

Human & Experimental Toxicology ◽

10.1177/0960327110390063 ◽

2010 ◽

Vol 30 (9) ◽

pp. 1165-1173 ◽

Cited By ~ 4

Author(s):

Manon Ceelen ◽

Tina Dorn ◽

Marcel Buster ◽

Joris Stomp ◽

Peter Zweipfenning ◽

...

Keyword(s):

Medical History ◽

Cause Of Death ◽

Urine Samples ◽

Post Mortem ◽

Urine Screening ◽

Preliminary Results ◽

Toxicology Screening ◽

Death Investigation ◽

Death Determination ◽

Indications For Use

This study evaluated standard toxicology screening by forensic physicians during external post-mortem examination. Collected urine samples of decedents were screened on-site for the presence of 10 commonly used drugs by means of a rapid multidrug test. Urine samples of 53% of the cases appeared to be positive for one or more compounds. Importantly, several cases were revealed which were positive for toxicology screening without indications for use of these drugs at the scene of death or from medical history. Based on these (preliminary) results, further action to incorporate routine post-mortem toxicology as a tool in forensic death investigation is recommended.

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Role of post-mortem computed tomography (PMCT) in the assessment of the challenging diagnosis of pericardial tamponade as cause of death in cases with hemopericardium

La radiologia medica ◽

10.1007/s11547-015-0517-1 ◽

2015 ◽

Vol 120 (8) ◽

pp. 723-730 ◽

Cited By ~ 8

Author(s):

Laura Filograna ◽

Patrick Laberke ◽

Garyfalia Ampanozi ◽

Wolf Schweitzer ◽

Michael J. Thali ◽

...

Keyword(s):

Computed Tomography ◽

Cause Of Death ◽

Pericardial Tamponade ◽

Post Mortem

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Clinical Relevance of Unexpected Findings of Post-Mortem Computed Tomography in Hospitalized Patients: An Observational Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207572 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7572

Author(s):

Max G. Mentink ◽

Bartholomeus G. H. Latten ◽

Frans C. H. Bakers ◽

Casper Mihl ◽

Roger J. M. W. Rennenberg ◽

...

Keyword(s):

Computed Tomography ◽

Observational Study ◽

Cause Of Death ◽

Clinical Relevance ◽

Clinical Care ◽

Hospitalized Patients ◽

Post Mortem ◽

Next Of Kin ◽

Conventional Autopsy ◽

Unexpected Findings

Background and objective: The current literature describing the use of minimally invasive autopsy in clinical care is mainly focused on the cause of death. However, the identification of unexpected findings is equally important for the evaluation and improvement of daily clinical care. The purpose of this study was to analyze unexpected post-mortem computed tomography (PMCT) findings of hospitalized patients and assess their clinical relevance. Materials and methods: This observational study included patients admitted to the internal medicine ward. Consent for PMCT and autopsy was requested from the next of kin. Decedents were included when consent for at least PMCT was obtained. Consent for autopsy was not obtained for all decedents. All findings reported by PMCT were coded with an International Classification of Diseases (ICD) code. Unexpected findings were identified and subsequently categorized for their clinical relevance by the Goldman classification. Goldman class I and III were considered clinically relevant. Additionally, correlation with autopsy results and ante-mortem imaging was performed. Results: In total, 120 decedents were included and evaluated for unexpected findings on PMCT. Of them, 57 decedents also underwent an autopsy. A total of 1020 findings were identified; 111 correlated with the cause of death (10.9%), 508 were previously reported (49.8%), 99 were interpreted as post-mortem changes (9.7%), and 302 were classified as unexpected findings (29.6%). After correlation with autopsy (in 57 decedents), 24 clinically relevant unexpected findings remained. These findings were reported in 18 of 57 decedents (32%). Interestingly, 25% of all unexpected findings were not reported by autopsy. Conclusion: Many unexpected findings are reported by PMCT in hospitalized patients, a substantial portion of which is clinically relevant. Additionally, PMCT is able to identify pathology and injuries not reported by conventional autopsy. A combination of PMCT and autopsy can thus be considered a more comprehensive and complete post-mortem examination.

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