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

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.

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

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.

scholarly journals Both Autopsy and Computed Tomography Are Necessary for Accurately Detecting Rib Fractures Due to Cardiopulmonary Resuscitation

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 697
Author(s):  
Kunio Hamanaka ◽  
Kei Nishiyama ◽  
Mami Nakamura ◽  
Marin Takaso ◽  
Masahito Hitosugi
Keyword(s):  
Computed Tomography ◽  
Logistic Regression ◽  
Cardiopulmonary Resuscitation ◽  
Observational Study ◽  
Logistic Regression Model ◽  
Kappa Coefficient ◽  
Rib Fractures ◽  
Post Mortem ◽  
Single Centre ◽  
Cpr Quality

Few studies have compared the sensitivities of autopsy and post mortem computed tomography (PMCT) in detecting rib fractures caused by cardiopulmonary resuscitation (CPR). We aimed to compare the characteristics between both modalities for accurately detecting CPR-related rib fractures. This single-centre observational study included adult patients with autopsy records and PMCT scans at our institution from January 2013 to March 2019. CPR-related rib fractures were evaluated using autopsy and PMCT findings. In 62 patients enrolled, 339 rib fractures were detected on autopsy and/or PMCT (222 fractures on both PMCT and autopsy, 69 on PMCT alone, and 50 on autopsy alone). The agreement of detection for both modalities was substantial (kappa coefficient, 0.78). In the logistic regression model, incomplete fractures detected by PMCT and age <75 years were significantly associated with findings that were negative on autopsy but positive on PMCT, while rib number (ribs 1–3 and 7–12) and fracture location (posterolateral and paravertebral) were significantly associated with negative PMCT findings but positive autopsy findings. Autopsy and PMCT showed complementary roles, and are thus necessary in accurately detecting CPR-related rib fractures. Combining both modalities may contribute to improved CPR quality and better understanding of discrepancy in characteristics between the two modalities.

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

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

scholarly journals Correction to: The value of postmortem computed tomography in paediatric natural cause of death: a Dutch observational study

2019 ◽  
Vol 49 (6) ◽  
pp. 840-840
Author(s):  
Rick R. van Rijn ◽  
◽  
Erik J. Beek ◽  
Elise M. van de Putte ◽  
Arianne H. Teeuw ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Observational Study ◽  
Cause Of Death ◽  
Postmortem Computed Tomography ◽  
Natural Cause Of Death

Comparison of conventional autopsy with post-mortem magnetic resonance, computed tomography in determining the cause of unexplained death

2021 ◽  
Vol 17 (1) ◽  
pp. 10-18
Author(s):  
Giuseppe Femia ◽  
Neil Langlois ◽  
Jim Raleigh ◽  
Belinda Gray ◽  
Farrah Othman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Post Mortem ◽  
Unexplained Death ◽  
Conventional Autopsy

scholarly journals 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

2015 ◽  
Vol 120 (8) ◽  
pp. 723-730 ◽  
Author(s):  
Laura Filograna ◽  
Patrick Laberke ◽  
Garyfalia Ampanozi ◽  
Wolf Schweitzer ◽  
Michael J. Thali ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cause Of Death ◽  
Pericardial Tamponade ◽  
Post Mortem

scholarly journals Effectiveness of Post-Mortem Computed Tomography (PMCT) in Comparison with Conventional Autopsy: A Systematic Review

2020 ◽  
Vol 16 (6) ◽  
pp. 669-676
Author(s):  
Deveshini Uthandi ◽  
Akmal Sabarudin ◽  
Zanariah Mohd ◽  
Mohd Amiruddin Abd Rahman ◽  
Muhammad Khalis Abdul Karim
Keyword(s):  
Computed Tomography ◽  
Systematic Review ◽  
Literature Search ◽  
Causes Of Death ◽  
Post Mortem ◽  
Internal Organs ◽  
Conventional Autopsy ◽  
Review Criteria ◽  
Insight Into ◽  
Missed Diagnoses

Background: With the advancement of technology, Computed Tomography (CT) scan imaging can be used to gain deeper insight into the cause of death. Aims: The purpose of this study was to perform a systematic review of the efficacy of Post- Mortem Computed Tomography (PMCT) scan compared with the conventional autopsies gleaned from literature published in English between the year 2009 and 2016. Methodology: A literature search was conducted on three databases, namely PubMed, MEDLINE, and Scopus. A total of 387 articles were retrieved, but only 21 studies were accepted after meeting the review criteria. Data, such as the number of victims, the number of radiologists and forensic pathologists involved, causes of death, and additional and missed diagnoses in PMCT scans were tabulated and analysed by two independent reviewers. Results: Compared with the conventional autopsy, the accuracy of PMCT scans in detecting injuries and causes of death was observed to range between 20% and 80%. The analysis also showed that PMCT had more advantages in detecting fractures, fluid in airways, gas in internal organs, major hemorrhages, fatty liver, stones, and bullet fragments. Despite its benefits, PMCT could also miss certain important lesions in a certain region such as cardiovascular injuries and minor vascular injuries. Conclusion: This systematic review suggests that PMCT can replace most of the conventional autopsies in specific cases and is also a good complementary tool in most cases.

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

BJR|Open ◽  
2019 ◽  
Vol 1 (1) ◽  
pp. 20190017
Author(s):  
Claire Robinson ◽  
Aparna Deshpande ◽  
Cathy Richards ◽  
Guy Rutty ◽  
Catherine Mason ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cause Of Death ◽  
Retrospective Review ◽  
Local Authority ◽  
Service Users ◽  
Post Mortem ◽  
Radiology Report ◽  
The Family ◽  
Death Investigation ◽  
The Cost

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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