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

Abstract

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-ofhospital, GP's population, especially to identify or exclude major (previously non-diagnosed) underlying diseases.

A 5-Year Retrospective Study on Infant Homicide Presenting as Cot Death

“…In the pediatric population, the absence of radiological evidence of injury cannot categorically exclude abuse, neglect, and/or homicide but also can miss injuries 23,24 . In addition, postmortem radiology studies in adults have shown that postmortem radiology has limitations in recognizing both natural diseases and injuries (soft tissue, nonossified bones, and ossified bones) 22,25–30 . Thus, using postmortem radiology as a screening tool to exclude unnatural and violent deaths in infants presenting as cot death is inadequate, unreliable, and against international standards.…”