Introduction of postmortem CT increases the postmortem examination rate without negatively impacting the rate of traditional autopsy in daily practice: an implementation study

Abstract

AimThe aim of this implementation study was to assess the effect of postmortem CT (PMCT) and postmortem sampling (PMS) on (traditional) autopsy and postmortem examination rates. Additionally, the feasibility of PMCT and PMS in daily practice was assessed.MethodsFor a period of 23 months, PMCT and PMS were used as additional modalities to the autopsy at the Department of Internal Medicine. The next of kin provided consent for 123 postmortem examinations. Autopsy rates were derived from the Dutch Pathology Registry, and postmortem examination rates were calculated for the period before, during and after the study period, and the exclusion rate, table time, time interval to informing the referring clinicians with results and the time interval to the Multidisciplinary Mortality Review Board (MMRB) meeting were objectified to assess the feasibility.ResultsThe postmortem examination rate increased (from 18.8% to 32.5%, p<0.001) without a decline in the autopsy rate. The autopsy rate did not change substantially after implementation (0.2% decrease). The exclusion rate was 2%, the table time was 23 min, and a median time interval of 4.1 hours between PMCT and discussing its results with the referring clinicians was observed. Additionally, more than 80% of the MMRB meetings were held within 8 weeks after the death of the patient.ConclusionsOur study shows that the implementation of a multidisciplinary postmortem examination is feasible in daily practice and does not adversely affect the autopsy rate, while increasing the postmortem examination rate.

Examination of the Cerebellomedullary Cistern Using Postmortem Computed Tomography in Various Types of Intracranial Hemorrhage

“…Normal postmortem changes in the brain include loss of gray-white matter differentiation and brain swelling with effacement of ventricles and cisterns, beginning immediately after death. Furthermore, the normal postmortem changes significantly affect the extent and imaging characteristics of SDH [9] and PMCT including postmortem sampling was suggested to be used as an adjunct rather than a substitute to autopsy [10,11].…”

Cause of death and the autopsy rate in an elderly population

“…Nonetheless, over the last decades, a steady worldwide decline of autopsies has been observed [3][4][5][6]. Several explanations for this decline have been proposed, such as the attitude of the public, clinicians, and pathologists [7][8][9], lack of education in medical curricula [10], a shift in care for older or sicker people from the hospital towards long-term facilities [11], the financial aspects [12], and advances in minimally invasive alternatives [13][14][15][16][17]. A recent Dutch study suggests that a key aspect for not requesting an autopsy is the assumption that the cause of death is already known [18].…”

Efficacy of postmortem CT and tissue sampling in establishing the cause of death in clinical practice: a prospective observational study

“…[14][15][16][17] Postmortem imaging with or without postmortem tissue sampling (PMS) could decrease the persistent trend of declining autopsy rates, possibly by an increased awareness for postmortem examinations. 18 Postmortem imaging has gained popularity over the past decade, and may provide a solution for accurate determination of COD despite declining postmortem examination rates. Postmortem CT (PMCT) and postmortem MRI (PMMR) have been introduced into the field of forensic medicine and both show promising results compared with traditional autopsy.…”