1
|
Margerin M, Ducloyer M, Morel B, Delbreil A, Mergy-Laurent M, Tasu JP, Dumas V. Imaging of sudden unexpected death in infancy: a comprehensive nationwide French survey. Pediatr Radiol 2024; 54:1720-1728. [PMID: 39115697 DOI: 10.1007/s00247-024-06013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/21/2024] [Accepted: 07/22/2024] [Indexed: 09/07/2024]
Abstract
RATIONALE AND OBJECTIVES Introduction of post-mortem imaging has helped improve sudden unexpected death in infancy (SUDI) management in Europe. French guidelines were issued in 2007 to homogenise SUDI investigations including imaging. The aim of this study was to evaluate current imaging management of SUDI in France. MATERIAL AND METHODS Between January 2022 and July 2022, all 35 SUDI French referral centres were invited to answer an e-mailed online survey including 29 questions divided into four different sections covering imaging practices for SUDI including radiology department organisation, imaging modalities performed, methods of reading, and current training resources. Partial responses were secondarily completed by a personal call to the SUDI imaging consultant. The current implementation of the 2007 recommendations was compared with a previous evaluation from 2015 and with current North American practices. RESULTS The participation rate of centres performing SUDI imaging was 100% (35/35). Imaging was systematically performed in 94.3% (33/35) of the centres: 74.3% (26/35) using radiography; 5.7% (2/35) using ultrasound; 94.3% (33/35) using computed tomography (CT), including 89% (31/35) whole-body CT and 5.7% (2/35) brain CT; and 20% (7/35) using magnetic resonance imaging (MRI). Two centres (5.7%, 2/35) did not systematically perform brain imaging. One (2.9%, 1/35) used ultrasound-guided biopsy. In comparison with 2015, rates of brain imaging increased by 25.4% (P=0.008). There was no significant difference in the number of forensic MRIs performed between France and North America (P=0.663). CONCLUSION Despite improvements since 2015, full compliance with French guidelines for SUDI investigations remains incomplete. The use of imaging, particularly CT and brain imaging, has increased. Further efforts are needed to standardise imaging practices for optimal SUDI investigations.
Collapse
Affiliation(s)
- Mathilde Margerin
- Department of Radiology, Poitiers University Medical Center, CHU Poitiers, 2 Rue de La Milétrie, 86000, Poitiers, France
| | - Mathilde Ducloyer
- Department of Forensic Medicine, Nantes University Medical Center, Nantes, France
| | - Baptiste Morel
- Department of Radiology, Tours University Medical Center, Tours, France
| | - Alexia Delbreil
- Department of Forensic Medicine, Poitiers University Medical Center, Poitiers, France
| | - Martine Mergy-Laurent
- Department of Radiology, Poitiers University Medical Center, CHU Poitiers, 2 Rue de La Milétrie, 86000, Poitiers, France
| | - Jean Pierre Tasu
- Department of Radiology, Poitiers University Medical Center, CHU Poitiers, 2 Rue de La Milétrie, 86000, Poitiers, France
- LaTIM, INSERM, UMR 1101, Bâtiment 1 CHRU Morvan - 2 Av. Foch, 29238, Brest, France
| | - Victor Dumas
- Department of Radiology, Poitiers University Medical Center, CHU Poitiers, 2 Rue de La Milétrie, 86000, Poitiers, France.
- LabCom I3M, DACTIM-MIS Team, LMA CNRS 7348, Poitiers University Medical Center, Poitiers, France.
| |
Collapse
|
2
|
Bruch GM, Hofer P, Ferraz da Silva LF, Pires-Davidson JR, Bento Dos Santos GA, Fischer FT. Pediatric postmortem CT angiography: validation of vascular access for PMCT angiography in stillbirths, babies and toddlers. Forensic Sci Med Pathol 2024; 20:627-635. [PMID: 37812319 PMCID: PMC11297117 DOI: 10.1007/s12024-023-00726-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE The use of angiography in postmortem CT angiography (PMCTA) has several advantages. In adults, femoral vascular access is well established. Due to the small and specific anatomy in fetuses and infants, the technique has to be adapted, especially regarding the vascular access. The aim of this study was to evaluate vascular access for pediatric PMCTA (pedPMCTA). MATERIALS AND METHODS Ten pedPMCTAs were performed in stillbirths, babies, and one toddler. A femoral approach by cannulation of the femoral artery and vein, an umbilical approach by cannulation of the umbilical vessels, and an intraosseous approach by an intraosseous needle were evaluated by handling and resulting imaging. RESULTS The insertion of a cannula with a size of 18-20 G in the femoral vessels was possible in babies. An umbilical access with peripheral venous cannulas with a size of 14-20 G was feasible in stillbirths and newborns. An intraosseous access is advisable as equal alternative to umbilical and in cases where a femoral access is not possible. The most significant problem with the vascular access is the extravasation of contrast media, but this can be reduced significantly with practice. CONCLUSION When performing pedPMCTA, an umbilical vascular access is recommended if an umbilical cord with open vessels is still present. Otherwise, a bone marrow access should be preferred in the presence of an arteriovenous shunt or if only the venous system needs to be shown. If that is not the case, the femoral access with the possibility to separate venous and arterial scan should be used.
Collapse
Affiliation(s)
- G M Bruch
- Institute of Forensic Medicine, LMU, Munich, Germany.
| | - P Hofer
- Institute of Forensic Medicine, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - L F Ferraz da Silva
- Faculdade de Medicina, Departamento de Patologia, Universidade de São Paulo, São Paulo, SP, Brazil
- São Paulo Autopsy Service, University of Sao Paulo, São Paulo, SP, Brazil
| | - J R Pires-Davidson
- Faculdade de Medicina, Departamento de Patologia, Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital Universitário de Brasília-Radiologia, Universidade de Brasília, Brasília, DF, Brazil
| | - G A Bento Dos Santos
- Faculdade de Medicina, Departamento de Patologia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - F T Fischer
- Institute of Forensic Medicine, LMU, Munich, Germany
| |
Collapse
|
3
|
Karaman G, Can IO, Cekdemir YE, Ekizoglu O, Guleryuz H. Age Estimation Based on Computed Tomography Analysis of the Scapula. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:581. [PMID: 38674226 PMCID: PMC11052407 DOI: 10.3390/medicina60040581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Age estimation from skeletal remains and in living individuals is an important issue for human identification, and also plays a critical role in judicial proceedings for migrants. Forensic analysis of ossification centers is the main evaluation method for age estimation, and ossification degree can be determined using computed tomography analysis. The purpose of this study is to investigate the applicability of CT (computed tomography) in the analysis of left scapula ossification centers, for forensic age estimation in Turkish society. Materials and Methods: We analyzed six ossification centers of the left scapula and these ossification centers are the coracoid, subcoracoid, coracoid apex, acromial, glenoid, and inferior angle ossification centers. A pediatric radiologist analyzed these six ossification centers of the scapula by using a staging method defined by Schmeling et al. in 2004. Two months after the first assessment, 20 randomly selected cases was reanalyzed by the first observer and by another pediatric radiologist. Correlation between the age and ossification stage was assessed using Spearman's nonparametric correlation test. Linear regression analysis was performed using a backwards model. Cohen's kappa coefficient was used for evaluating interobserver and intraobserver variability. Results: In this retrospective study, 397 (248 male and 149 female) cases were evaluated. Ages ranged between 7.1 and 30.9. The mean age was 19.83 ± 6.49. We determined a positive significant correlation between the age and the ossification stages of ossification centers analyzed in both sexes. In each ossification center, except inferior angle, all of the stage 1 and 2 cases in both sexes were under 18 years old. Intraobserver and interobserver evaluations showed that reproducibility and consistency of the method was relatively good. Conclusions: The present study indicated that CT analysis of scapula ossification centers might be helpful in forensic age assessment of living individuals and dry bones.
Collapse
Affiliation(s)
- Gokçe Karaman
- Turgutlu Forensic Medicine Department, Council of Forensic Medicine, 45400 Manisa, Turkey
| | - Ismail Ozgur Can
- Forensic Medicine Department, Faculty of Medicine, Dokuz Eylül University, 35220 İzmir, Turkey;
| | - Yasin Ertug Cekdemir
- Radiology Department, Faculty of Medicine, Dokuz Eylül University, 35220 İzmir, Turkey; (Y.E.C.); (H.G.)
| | - Oguzhan Ekizoglu
- Unit of Forensic Imaging and Anthropology, University Centre of Legal Medicine Lausanne-Geneva, Geneva University Hospital and University of Geneva, 1015 Lausanne, Switzerland;
- Department of Forensic Medicine, Tepecik Training and Research Hospital, 35180 Izmir, Turkey
| | - Handan Guleryuz
- Radiology Department, Faculty of Medicine, Dokuz Eylül University, 35220 İzmir, Turkey; (Y.E.C.); (H.G.)
| |
Collapse
|
4
|
Edwards H, Shelmerdine SC, Arthurs OJ. Forensic post-mortem CT in children. Clin Radiol 2023; 78:839-847. [PMID: 37827594 DOI: 10.1016/j.crad.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/30/2023] [Accepted: 06/02/2023] [Indexed: 10/14/2023]
Abstract
Post-mortem computed tomography (PMCT) imaging is gaining popularity and acceptance for use alongside forensic autopsies of children, predominantly to aid in the detection of traumatic injuries. Recent research on this topic has provided a breadth of new information regarding the appropriate usage, imaging guidance, and diagnostic accuracy for the identification of different paediatric pathologies. Additionally, advanced CT imaging techniques, such as PMCT angiography or ventilated PMCT, have been trialled, and post-mortem micro-CT is now being used in specialist centres for the assessment of subtle fractures in extracted bone specimens. Various image post-processing methods (e.g., three-dimensional printing from PMCT imaging data) are being used for the illustration of injuries in the medicolegal setting to a lay audience and provide another avenue for the future of forensic radiology research. In this review, the evidence-based principles and benefits of post-mortem imaging for forensic investigation in childhood deaths are presented, with a particular focus on PMCT and current practices. Variations in forensic imaging strategies around the world, published diagnostic accuracy rates, and expected normal post-mortem imaging findings are discussed, as well as potential future applications and research in this area.
Collapse
Affiliation(s)
- H Edwards
- Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
| | - S C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, UK
| | - O J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK; UCL Great Ormond Street Institute of Child Health, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, UK.
| |
Collapse
|
5
|
Wickramasinghe CU, Edussuriya D, Perera S, Herath N. Usefulness of virtual autopsy in diagnosing pathologies in the paediatric population: A systematic review. SAGE Open Med 2023; 11:20503121231172002. [PMID: 37197019 PMCID: PMC10184261 DOI: 10.1177/20503121231172002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/10/2023] [Indexed: 05/19/2023] Open
Abstract
Objective Virtual autopsy is a non-invasive/minimally invasive method for conducting an autopsy, with the assistance of imaging techniques. We aim to review the benefits of virtual autopsy in detecting pathologies in the paediatric population. Method The procedure adhered to Institute of Medicine and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Seven databases including MEDLINE and SCOPUS were searched for articles published 2010-2020 worldwide in English. A narrative synthesis of the findings of included studies was carried out to discuss and summarize the results of the review. Results From 686 studies on paediatric deaths, 23 met selection/quality criteria. Virtual autopsy was better than conventional autopsy in detecting skeletal lesions and bullet trajectory, thus a crucial tool in the investigation of traumatic and firearm deaths. Virtual autopsy was superior to conventional autopsy in identifying the point of bleeding in postoperative deaths and objectively quantifying air/fluid in body cavities. Virtual autopsy was a useful adjunct for detecting pulmonary thrombo-embolism, foreign body aspiration, drowning and metastatic malignancies. The use of non-contrast imaging in investigating natural paediatric deaths did not offer more information than conventional autopsy. Misinterpretation of normal post-mortem changes as pathological findings was another disadvantage of virtual autopsy leading to erroneous conclusions. But accuracy may be improved with contrast enhancement and post-mortem magnetic resonance imaging. Conclusion Virtual autopsy is a crucial tool in the investigation of traumatic and firearm deaths in the paediatric population. Virtual autopsy will be useful as an adjunct to conventional autopsy in asphyxial deaths, stillbirths and decomposed bodies. Virtual autopsy has limited value in differentiating antemortem and post-mortem changes with the added risk of misinterpretations, therefore should be used with caution in natural deaths.
Collapse
Affiliation(s)
- Chathula Ushari Wickramasinghe
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Chathula Ushari Wickramasinghe, Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka.
| | - Deepthi Edussuriya
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sriyani Perera
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nimashi Herath
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| |
Collapse
|
6
|
Speelman AC, Engel-Hills PC, Martin LJ, van Rijn RR, Offiah AC. Postmortem computed tomography plus forensic autopsy for determining the cause of death in child fatalities. Pediatr Radiol 2022; 52:2620-2629. [PMID: 35732843 DOI: 10.1007/s00247-022-05406-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/06/2022] [Accepted: 05/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postmortem computed tomography (CT) and magnetic resonance imaging have been gradually introduced to forensic pathology centres over the past two decades, with varying results in comparison to autopsy. OBJECTIVE The purpose of this study was to determine the accuracy of postmortem CT in determining a cause of death in children who died of unnatural causes. MATERIALS AND METHODS This was a prospective recruitment of 30 children (< 18 years) who underwent postmortem CT and a forensic autopsy. A cause of death was independently assigned by two experienced paediatric radiologists and compared to that of the forensic autopsy. RESULTS A correct cause of death was assigned by reviewers 1 and 2 in 70% (n = 21/30) and 67% (n = 20/30) of cases, respectively. For gunshot injuries and blunt force head injuries, there was 91% (n = 10/11) and 100% (n = 6/6) agreement between forensic autopsy and both reviewers, respectively. No cause of death could be assigned by reviewers 1 and 2 in 27% (n = 8) and 30% (n = 9) of cases, respectively. An incorrect cause of death was assigned by both reviewers in one case (3%). The Cohen Kappa level of agreement between the forensic autopsy and reviewers 1 and 2 was k = 0.624 (95% confidence interval [CI]: 0.45-0.80, P = 0) and k = 0.582 (95% CI 0.41-0.76, P = 0), respectively. There was near perfect agreement between reviewers 1 and 2 (k = 0.905) (95% CI 0.78-1.00, P = 0). CONCLUSION Postmortem CT has good diagnostic accuracy for identifying a cause of death related to trauma, but it has poor accuracy for children dying from causes not associated with apparent physical injury.
Collapse
Affiliation(s)
- Aladdin C Speelman
- Radiography (Diagnostic), Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, 7530, Cape Town, South Africa.
| | - Penelope C Engel-Hills
- Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, 7530, Cape Town, South Africa
| | - Lorna J Martin
- Division of Forensic Medicine & Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands
| | - Amaka C Offiah
- University of Sheffield and Sheffield Children's NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
7
|
Lyness JR, Collins AJ, Rutty JE, Rutty GN. Comparison of findings identified at traditional invasive autopsy and postmortem computed tomography in suicidal hangings. Int J Legal Med 2022; 136:1865-1881. [PMID: 35960370 PMCID: PMC9576641 DOI: 10.1007/s00414-022-02874-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022]
Abstract
Cases of suicidal hanging are a common death referred for medico-legal autopsy throughout the world. Although some advocate using postmortem computed tomography (PMCT) without traditional invasive autopsy (TIA) to investigate such deaths, others reject this approach. There is currently limited evidence to guide practice. In this context, the TIA reports and PMCT images of 50 cases of suspected suicidal hanging during an 11-month period were reviewed. The reviewers were blinded to the findings of the other modality. A Cohen’s Kappa coefficient (K) was calculated to assess agreement between TIA and PMCT across a range of pertinent findings. This analysis demonstrated perfect agreement for identification of a ligature (K = 1.00) and a strong level of agreement for identification of a ligature suspension point (K = 0.832) but only a minimal level of agreement for overall ligature mark (K = 0.223). PMCT demonstrated a weak level of agreement for fractures of hyoid bone (K = 0.555) and thyroid cartilage (K = 0.538). Three probable fractures not identified at TIA were identified on PMCT. TIA was shown to be superior in the identification of intramuscular and laryngeal fracture–related haemorrhage/bruising whereas PMCT was superior to TIA in identifying body gas deposition. There was overall good correlation between the natural disease and trauma identified elsewhere in the body during the TIA and PMCT. The study demonstrates that PMCT can assist the investigation of suspected suicidal hangings. However, the accuracy of many findings is limited, and if it is used as an alternative to the TIA, potentially pertinent findings, such as fractures of the laryngeal cartilages, could be missed.
Collapse
Affiliation(s)
| | | | - Jane E Rutty
- The Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Guy N Rutty
- East Midlands Forensic Pathology Unit, University of Leicester, Leicester, UK
| |
Collapse
|
8
|
Shelmerdine SC, Arthurs OJ. Post-mortem perinatal imaging: what is the evidence? Br J Radiol 2022:20211078. [PMID: 35451852 DOI: 10.1259/bjr.20211078] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Post-mortem imaging for the investigation of perinatal deaths is an acceptable tool amongst parents and religious groups, enabling a less invasive autopsy examination. Nevertheless, availability is scarce nationwide, and there is some debate amongst radiologists regarding the best practice and optimal protocols for performing such studies. Much of the published literature to date focusses on single centre experiences or interesting case reports. Diagnostic accuracy studies are available for a variety of individual imaging modalities (e.g. post-mortem CT, MRI, ultrasound and micro-CT), however, assimilating this information is important when attempting to start a local service.In this article, we present a comprehensive review summarising the latest research, recently published international guidelines, and describe which imaging modalities are best suited for specific indications. When the antenatal clinical findings are not supported by the post-mortem imaging, we also suggest how and when an invasive autopsy may be considered. In general, a collaborative working relationship within a multidisciplinary team (consisting of radiologists, radiographers, the local pathology department, mortuary staff, foetal medicine specialists, obstetricians and bereavement midwives) is vital for a successful service.
Collapse
Affiliation(s)
- Susan C Shelmerdine
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, 30 Guilford Street, Bloomsbury, London, UK.,Department of Radiology, St. George's Hospital, Blackshaw Road, London, UK
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,UCL Great Ormond Street Institute of Child Health, London, UK.,NIHR Great Ormond Street Hospital Biomedical Research Centre, 30 Guilford Street, Bloomsbury, London, UK
| |
Collapse
|
9
|
Ducloyer M, Carballeira-Alvarez A, Tuchtan L, Delteil C, Piercecchi-Marti MD, Gorincour G, Prodhomme O. Normal Post-mortem Imaging Findings in Foetuses and Children. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Child Abuse, a Post-mortem Forensic Perspective. FORENSIC IMAGING 2022. [DOI: 10.1007/978-3-030-83352-7_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
11
|
Loos MLHJ, Bakx R, Duijst WLJM, Aarts F, de Blaauw I, Bloemers FW, Ten Bosch JA, Evers M, Greeven APA, Hondius MJ, van Hooren RLJH, Huisman E, Hulscher JBF, Keyzer-Dekker CMG, Krug E, Menke J, Naujocks T, Reijnders UJL, de Ridder VA, Spanjersberg WR, Teeuw AH, Theeuwes HP, Vervoort-Steenbakkers W, de Vries S, de Wit R, van Rijn RR. High prevalence of non-accidental trauma among deceased children presenting at Level I trauma centers in the Netherlands. Forensic Sci Med Pathol 2021; 17:621-633. [PMID: 34773580 PMCID: PMC8629892 DOI: 10.1007/s12024-021-00416-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/30/2022]
Abstract
Purpose Between 0.1—3% of injured children who present at a hospital emergency department ultimately die as a result of their injuries. These events are typically reported as unnatural causes of death and may result from either accidental or non-accidental trauma (NAT). Examples of the latter include trauma that is inflicted directly or resulting from neglect. Although consultation with a forensic physician is mandatory for all deceased children, the prevalence of fatal inflicted trauma or neglect among children is currently unclear. Methods This is a retrospective study that included children (0–18 years) who presented and died at one of the 11 Level I trauma centers in the Netherlands between January 1, 2014, and January 1, 2019. Outcomes were classified based on the conclusions of the Child Abuse and Neglect team or those of forensic pathologists and/or the court in cases referred for legally mandated autopsies. Cases in which conclusions were unavailable and there was no clear accidental cause of death were reviewed by an expert panel. Results The study included 175 cases of childhood death. Seventeen (9.7%) of these children died due to inflicted trauma (9.7%), 18 (10.3%) due to neglect, and 140 (80%) due to accidents. Preschool children (< 5 years old) were significantly more likely to present with injuries due to inflicted trauma and neglect compared to older children (44% versus 6%, p < 0.001, odds ratio [OR] 5.80, 95% confidence interval [CI] 2.66–12.65). Drowning accounted for 14 of the 18 (78%) pediatric deaths due to neglect, representing 8% of the total cases. Postmortem radiological studies and autopsies were performed on 37 (21%) of all cases of childhood death. Conclusion One of every five pediatric deaths in our nationwide Level I trauma center study was attributed to NAT; 44% of these deaths were the result of trauma experienced by preschool-aged children. A remarkable number of fatal drownings were due to neglect. Postmortem radiological studies and autopsies were performed in only one-fifth of all deceased children. The limited use of postmortem investigations may have resulted in missed cases of NAT, which will result in an overall underestimation of fatal NAT experienced by children. Supplementary information The online version contains supplementary material available at 10.1007/s12024-021-00416-7.
Collapse
Affiliation(s)
- Marie-Louise H J Loos
- Amsterdam UMC, Department of Paediatric Surgery, Emma Children's Hospital, Paediatric Surgical Centre Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Roel Bakx
- Amsterdam UMC, Department of Paediatric Surgery, Emma Children's Hospital, Paediatric Surgical Centre Amsterdam, University of Amsterdam & Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Wilma L J M Duijst
- Department of Forensic Medicine, GGD IJsselland, Zwolle, the Netherlands
- Criminal Law and Criminology, Faculty of Law, Maastricht University, Maastricht, the Netherlands
| | - Francee Aarts
- Department of Forensic Medicine, GGD Nijmegen, Nijmegen, the Netherlands
| | - Ivo de Blaauw
- Department of Paediatric Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Jan A Ten Bosch
- Department of Trauma Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Martina Evers
- Department of Forensic Medicine, GGD Euregio, Enschede, the Netherlands
- Department of Surgery, Haga Teaching Hospital & Juliana Children's Hospital, The Hague, the Netherlands
| | | | | | | | - Erik Huisman
- Department of Forensic Medicine, GGD Haaglanden, The Hague, the Netherlands
- GGD Hollands-Midden, Department of Forensic Medicine, Leiden, the Netherlands
| | - Jan B F Hulscher
- Department of Surgery, Division of Paediatric Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - Claudia M G Keyzer-Dekker
- Erasmus Medical Centre, Department of Paediatric Surgery, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Egbert Krug
- Department of Trauma Surgery, Leiden University Medical Centre, Leiden, the Netherlands
| | - Jack Menke
- Forensisch Artsen Rotterdam-Rijnmond' (FARR), Rotterdam, the Netherlands
| | - Tatjana Naujocks
- GGD Groningen, Department of Forensic Medicine, Groningen, the Netherlands
| | - Udo J L Reijnders
- Department of Forensic Medicine, GGD Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Victor A de Ridder
- Department of Paediatric Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Arianne H Teeuw
- Amsterdam UMC, Department of Social Paediatrics, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Hilco P Theeuwes
- Department of Trauma Surgery, Elizabeth TweeSteden Hospital, Tilburg, the Netherlands
| | | | - Selena de Vries
- Department of Forensic Medicine, Section On Forensic Paediatrics, Netherlands Forensic Institute, The Hague, The Netherlands
| | - Ralph de Wit
- Department of Trauma Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Rick R van Rijn
- Department of Forensic Medicine, Section On Forensic Paediatrics, Netherlands Forensic Institute, The Hague, The Netherlands
- Amsterdam UMC, Department of Radiology and Nuclear Medicine, Emma Children's Hospital, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Center for Forensic Science and Medicine, Amsterdam, The Netherlands
| |
Collapse
|
12
|
Ducloyer M, David A, Dautreme B, Tournel G, Vincent F, Clement R, Tuchtan L, Delteil C, Gorincour G, Dedouit F. Pictorial review of the postmortem computed tomography in neonaticide cases. Int J Legal Med 2021; 135:2395-2408. [PMID: 34383117 DOI: 10.1007/s00414-021-02677-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/26/2021] [Indexed: 11/24/2022]
Abstract
Neonaticide is defined by the deliberate killing or homicide of a child within 24 h of its birth. In this context, three fundamental questions are generally asked of the forensic pathologist: what is the cause of death of the neonate? Was the child viable (i.e., what is the gestational age of the neonate)? Finally, was the neonate stillborn or liveborn?Postmortem imaging can help answer these questions by conducting (1) a complete lesional analysis of the body and the placenta, (2) an estimation of the gestational age by measuring the lengths of the diaphyseal long bones, and (3) an analysis of the aeration of the lungs and intestines. Using the details of 18 cases, we illustrate aspects of neonaticide cases in postmortem computed tomography (PMCT), offering detailed examples of notable postmortem changes and abnormalities, especially in the analysis of the pulmonary parenchyma. This article presents a useful iconography for the radiologist confronted with this rare yet complex forensic situation.
Collapse
Affiliation(s)
- Mathilde Ducloyer
- Forensic Department, University Hospital, 30 Boulevard Jean Monnet, 44000, Nantes, France. .,Department of Radiology, Hotel Dieu, University Hospital, Nantes, France. .,GRAVIT, Groupe de Recherche en Autopsie Virtuelle Et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France.
| | - Arthur David
- Department of Radiology, Hotel Dieu, University Hospital, Nantes, France
| | - Bérengère Dautreme
- Forensic Department, University Hospital, Rouen, France.,UTMLA 7367, University of Lille, Lille, France
| | - Gilles Tournel
- Forensic Department, University Hospital, Rouen, France.,EA 4651 ABTE, University of Rouen, Rouen, France
| | | | - Renaud Clement
- Forensic Department, University Hospital, 30 Boulevard Jean Monnet, 44000, Nantes, France
| | - Lucile Tuchtan
- CNRS, EFS, ADES, Aix Marseille Univ, 27 Avenue Jean Moulin, 13385, Marseille, France.,Forensic Department, APHM, La Timone, 264 Rue St Pierre, 13385, Marseille Cedex 05, France
| | - Clémence Delteil
- Forensic Department, APHM, La Timone, 264 Rue St Pierre, 13385, Marseille Cedex 05, France
| | - Guillaume Gorincour
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle Et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France.,Elsan, Clinique Bouchard, Marseille, France
| | - Fabrice Dedouit
- GRAVIT, Groupe de Recherche en Autopsie Virtuelle Et Imagerie Thanatologique, Forensic Department, University Hospital, Rangueil, Toulouse, France.,Forensic Department, University Hospital, Rangueil, Toulouse, France
| |
Collapse
|
13
|
Harty MP, Gould SW, Harcke HT. Navigating the perils and pitfalls of pediatric forensic postmortem imaging in the United States. Pediatr Radiol 2021; 51:1051-1060. [PMID: 33999245 DOI: 10.1007/s00247-020-04833-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 05/28/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
Postmortem CT is widely used in the general adult and military populations. It is used extensively in pediatric death investigations in Europe and Asia, but distinctive challenges are encountered when launching a postmortem imaging program in the United States. We describe the issues we have encountered specific to establishing a pediatric postmortem imaging service in this country and propose potential solutions.
Collapse
Affiliation(s)
- Mary P Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Howard T Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| |
Collapse
|
14
|
O’Rahelly M, McDermott M, Healy M. Autopsy and pre-mortem diagnostic discrepancy review in an Irish tertiary PICU. Eur J Pediatr 2021; 180:3519-3524. [PMID: 34137920 PMCID: PMC8210522 DOI: 10.1007/s00431-021-04155-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/28/2021] [Accepted: 06/09/2021] [Indexed: 12/01/2022]
Abstract
Our study had two objectives: (1) to review ante- and post-mortem diagnoses and assign a Goldman error classification and (2) establish autopsy rates within our centre. We performed a retrospective analysis of autopsies performed on patients who died in our paediatric intensive care unit (PICU) between November 13, 2012, and October 31, 2018. Medical and autopsy data of all patients was reviewed, and Goldman classification of discrepancy between ante- and post-mortem diagnoses was assigned. Our centre is a tertiary PICU, and we included all patients that died in PICU within the designated timeframe. Our results were as follows: 396 deaths occurred in PICU from 8329 (4.75%) admissions. Ninety-nine (25%) had an autopsy, 75 required by the coroner. All were included in the study. Fifty-three were male and 46 females. Fifty-three patients were transferred from external hospitals, 46 from our centre. Forty-one were neonates, 32 were < 1 year of age, and 26 were > 1 year of age. The median length of stay was 3 days. Eighteen were post-cardiac surgery, and three post-cardiac catheter procedure. Major diagnostic errors (class I/II) were identified in 14 (14.1%), 2 (2%) class I, and 12 (12.1%) were class II errors. Class III and IV errors occurred in 28 (28.2%) patients. Complete concordance (class V) occurred in 57 (57.5%) cases.Conclusion: We conclude that the autopsy rate and the diagnostic discrepancy rate within our PICU are comparable to those previously reported. Our findings show the continuing value of autopsy in determining the cause of death and providing greater diagnostic clarity. Given their value, post-mortem examinations, where indicated, should be considered part of a physician's duty of care to families and future patients. What is Known: • Major diagnostic discrepancies (class I/II) in PICU have been reported at 20.2%. (10) • PICU autopsy rates have varied from 36 to 67% since 1994 with most recently reported rates in 2018 being 36%. (6-9) What is New: • We report an Irish PICU major diagnostic discrepancy (class I/II) rates of 14.1% contributing further to reported discrepancy rates in PICU literature to date. • This study contributes the Irish PICU post-mortem rate in a tertiary centre which was 25% over an almost 6-year period.
Collapse
Affiliation(s)
- Mark O’Rahelly
- Department of Anesthesia and Critical Care, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Michael McDermott
- Department of Pathology, Children’s Health Ireland at Crumlin, Dublin, Ireland
| | - Martina Healy
- Department of Anesthesia and Critical Care, Children’s Health Ireland at Crumlin, Dublin, Ireland
| |
Collapse
|
15
|
Transposition of the Suchey–Brooks and spheno-occipital synchondrosis fusion methods onto computed tomographic images: review and future prospects. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
16
|
Ishida M, Gonoi W, Shirota G, Abe H, Shintani-Domoto Y, Ikemura M, Ushiku T, Abe O. Utility of unenhanced postmortem computed tomography for investigation of in-hospital nontraumatic death in children up to 3 years of age at a single Japanese tertiary care hospital. Medicine (Baltimore) 2020; 99:e20130. [PMID: 32384493 PMCID: PMC7220630 DOI: 10.1097/md.0000000000020130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
To evaluate the utility of unenhanced postmortem computed tomography (PMCT) for the investigation of in-hospital nontraumatic death in children up to 3 years of age.This study included the cadavers of children who died from intrinsic diseases before 3 years of age. The major underlying disease and the main organ-disease systems associated with the immediate causes of death were determined by clinical evaluation, PMCT, and autopsy, which were used as a reference standard. The rates of concordance between the former two methods and autopsy were calculated for all cases.In total, 22 cadavers (12 male and 10 female; mean age, 6.1 ± 8.2 months) were included. The rates of concordance between clinical evaluation/PMCT and autopsy for diagnosis of the major underlying disease and main organ-disease systems associated with the immediate causes of death were 100%/36% (P = .0015) and 59%/41% (P = .37), respectively. In cases where the respiratory system was associated with the immediate cause of death, PMCT showed greater diagnostic sensitivity (90%) than did clinical evaluation (20%). In contrast, the diagnostic sensitivity of PMCT was lower than that of clinical evaluation in cases involving disorders of the cardiac system and multiple organ systems (0% vs 100% for both).The findings of this study suggest that the use of unenhanced PMCT with clinical evaluation can result in improved detection of the immediate cause of death in select cases of in-hospital nontraumatic death before 3 years of age.
Collapse
Affiliation(s)
| | | | | | - Hiroyuki Abe
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yukako Shintani-Domoto
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masako Ikemura
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | | |
Collapse
|
17
|
Gould SW, Harty MP, Givler NE, Christensen TE, Curtin RN, Harcke HT. Pediatric postmortem computed tomography: initial experience at a children's hospital in the United States. Pediatr Radiol 2019; 49:1113-1129. [PMID: 31201439 DOI: 10.1007/s00247-019-04433-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/17/2019] [Accepted: 05/16/2019] [Indexed: 12/18/2022]
Abstract
Postmortem CT might provide valuable information in determining the cause of death and understanding disease processes, particularly when combined with traditional autopsy. Pediatric applications of postmortem imaging represent a new and rapidly growing field. We describe our experience in establishing a pediatric postmortem CT program and present a discussion of the distinct challenges in developing this type of program in the United States of America, where forensic practice varies from other countries. We give a brief overview of recent literature along with the common imaging findings on postmortem CT that can simulate antemortem pathology.
Collapse
Affiliation(s)
- Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - M Patricia Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Nicole E Givler
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Theresa E Christensen
- Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Riley N Curtin
- Department of Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Howard T Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| |
Collapse
|
18
|
Diagnostic Accuracy of Postmortem CT of Children: A Retrospective Single-Center Study. AJR Am J Roentgenol 2019; 212:1335-1347. [PMID: 30917029 DOI: 10.2214/ajr.18.20534] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE. The objective of our study was to determine the diagnostic accuracy of postmortem CT in children compared with standard autopsy. MATERIALS AND METHODS. This single-center retrospective study reviewed un-enhanced whole-body postmortem CT examinations of children less than 16 years old with corresponding autopsy reports irrespective of the clinical indication for referral for postmortem CT. Perinatal deaths were excluded. Postmortem CT was reported by experienced postmortem radiologists who were blinded to autopsy findings, with the primary outcome being concordance for the main pathologic diagnosis or findings leading to a cause of death. Autopsy performed by pediatric pathologists was the reference standard. RESULTS. One hundred thirty-six patients (74 [54.4%] male and 62 [45.6%] female patients) were included. The mean age of the 136 patients was 2 years 1 month (range, 2 days-14.7 years). A cause of death at autopsy was found for 77 of the 136 (56.6%) patients. Postmortem CT depicted a correct cause of death in 55 of 77 (71.4%) patients; (55/136 overall [40.4%]), with the majority attributable to traumatic brain or body injuries. For major pathologic findings, diagnostic accuracy rates were a sensitivity of 71.4% (95% CI, 60.5-80.3%), specificity of 81.4% (95% CI, 69.6-89.3%), positive predictive value of 83.3% (95% CI, 72.6-90.4%), negative predictive value of 68.6% (95% CI, 57.0-78.2%), and concordance rate of 75.7% (95% CI, 67.9-82.2%). The sensitivity of postmortem CT versus autopsy was highest for intracranial (75.6%; 95% CI, 60.7-86.2%) and musculoskeletal (98.4%; 95% CI, 91.4-99.7%) abnormalities and lowest for cardiac (31.3%; 95% CI, 14.2-55.6%) and abdominal (53.8%; 95% CI, 29.1-78.6%) findings. CONCLUSION. Postmortem CT gives an acceptable diagnostic concordance rate with autopsy of 71.4%, although identification of the cause of death overall was low at 40.4%. The highest accuracy rates were for intracranial and musculoskeletal abnormalities.
Collapse
|
19
|
Shelmerdine SC, Sebire NJ, Arthurs OJ. Perinatal post mortem ultrasound (PMUS): a practical approach. Insights Imaging 2019; 10:35. [PMID: 30887398 PMCID: PMC6423182 DOI: 10.1186/s13244-019-0723-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/16/2019] [Indexed: 01/05/2023] Open
Abstract
Declining rates of consent for standard perinatal autopsy has led to a rise in interest for postmortem imaging as an alternative, non-invasive method for investigation of childhood and perinatal deaths. Whilst much interest has focussed on cross-sectional techniques such as postmortem CT (PMCT) or MRI (PMMR), other modalities including postmortem ultrasound (PMUS) have been shown to have reasonable diagnostic accuracy rates, with the added benefit of being more readily accessible and affordable. There is little published information or formal guidance available on preparation for postmortem perinatal ultrasound, views to be obtained and differentiating normal postmortem change from potential abnormalities. This article will focus on the role of perinatal postmortem ultrasound as an alternative imaging method for non-invasive autopsy, with emphasis on imaging technique, practical considerations and commonly encountered case examples.
Collapse
Affiliation(s)
- Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK. .,UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Neil J Sebire
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.,UCL Great Ormond Street Institute of Child Health, London, UK
| |
Collapse
|
20
|
Shelmerdine SC, Gerrard CY, Rao P, Lynch M, Kroll J, Martin D, Miller E, Filograna L, Martinez RM, Ukpo O, Daly B, Hyodoh H, Johnson K, Watt A, Taranath A, Brown S, Perry D, Boel LWT, Borowska-Solonynko A, van Rijn R, Klein W, Whitby E, Arthurs OJ. Joint European Society of Paediatric Radiology (ESPR) and International Society for Forensic Radiology and Imaging (ISFRI) guidelines: paediatric postmortem computed tomography imaging protocol. Pediatr Radiol 2019; 49:694-701. [PMID: 30815716 PMCID: PMC6459792 DOI: 10.1007/s00247-018-04340-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 10/29/2018] [Accepted: 12/20/2018] [Indexed: 11/30/2022]
Abstract
Postmortem CT for investigating childhood deaths is increasingly utilised as a noninvasive adjunct or alternative to standard autopsy; however there are no standardised published imaging protocols. This article describes a standardised imaging protocol that has been developed based on current practices of international postmortem imaging practitioners and experts. This recommendation is expected to be useful for postmortem imaging centres wishing to update their existing practices and for those starting paediatric postmortem CT as a new service.
Collapse
Affiliation(s)
- Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK
| | - Chandra Y Gerrard
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Padma Rao
- Department of Medical Imaging, Victorian Institute of Forensic Medicine & Royal Children's Hospital, Melbourne, Australia
| | - Matthew Lynch
- Department of Medical Imaging, Victorian Institute of Forensic Medicine & Royal Children's Hospital, Melbourne, Australia
| | - Jeroen Kroll
- Department of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dan Martin
- Department of Radiology, Gold Coast University Hospital, Gold Coast, Australia
| | - Elka Miller
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Laura Filograna
- Department of Diagnostic and Interventional Radiology, "Tor Vergata" University of Rome, Rome, Italy
| | - Rosa Maria Martinez
- Institute of Forensic Medicine (Virtopsy), University of Zurich, Zurich, Switzerland
| | - Odey Ukpo
- Los Angeles County Medical Examiner-Coroner Office, Los Angeles, CA, USA
| | - Barry Daly
- Office of the Chief Medical Examiner, University of Maryland, Baltimore, MD, USA
| | - Hideki Hyodoh
- Center for Cause of Death Investigation, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Karl Johnson
- Department of Radiology, Birmingham Children's Hospital, Birmingham, UK
| | - Andrew Watt
- Department of Diagnostic Imaging & Clinical Physics, The Royal Hospital for Children, Glasgow, Scotland, UK
| | - Ajay Taranath
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Scott Brown
- Department of Medical Imaging, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - David Perry
- Radiology Department, National Women's Health and Starship Children's Hospital, Auckland City Hospital, Auckland, New Zealand
| | | | | | - Rick van Rijn
- Department of Radiology, Emma Children's Hospital, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Willemijn Klein
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Elspeth Whitby
- Academic Unit of Radiology, University of Sheffield, Sheffield, UK
| | - Owen J Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.
- UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, UK.
| |
Collapse
|
21
|
Shelmerdine S, Langan D, Sebire NJ, Arthurs O. Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review. BMJ Paediatr Open 2019; 3:e000566. [PMID: 31799452 PMCID: PMC6863669 DOI: 10.1136/bmjpo-2019-000566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Ultrasound is ubiquitous in live paediatric imaging; however, its usage in post-mortem setting is less established. This systematic review aims to evaluate the diagnostic accuracy of paediatric post-mortem ultrasound (PMUS). DESIGN MEDLINE, Embase and Cochrane Library databases were queried for studies published between 1998 and 2018 assessing PMUS diagnostic accuracy rates in children<18 years old, using autopsy as reference standard. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2. A bivariate random-effects model was used to obtain combined mean estimates of sensitivity and specificity for different body systems. RESULTS Four studies were included, all relating to ultrasound for perinatal deaths. The mean diagnostic sensitivity and specificity for neurological abnormalities were 84.3% (95% CI: 70.8% to 92.2%) and 96.7% (95% CI: 86.5% to 99.3%); for cardiothoracic abnormalities 52.1% (95% CI: 27.6% to 75.5%,) and 96.6% (95% CI: 86.8% to 99.2%); and for abdominal abnormalities 78.4% (95% CI: 61.0% to 89.4%) and 97.3% (95% CI: 88.9% to 99.4%). Combining all body systems, the mean sensitivity and specificity were 73.3% (95% CI: 59.9% to 83.5%) and 96.6% (95% CI: 92.6% to 98.4%). CONCLUSIONS PMUS demonstrates a reasonable diagnostic accuracy, particularly for abdominal and neurological abnormalities, although cardiac anomalies were less readily identified. TRIAL REGISTRATION NUMBER CRD42018106968.
Collapse
Affiliation(s)
- Susan Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.,UCL GOSH ICH, London, UK
| | | | - Neil J Sebire
- UCL GOSH ICH, London, UK.,Department of Paediatric Pathology, Great Ormond Street Hospital for Children, London, UK
| | - Owen Arthurs
- Department of Clinical Radiology, Great Ormond Street Hospital for Children, London, UK.,UCL GOSH ICH, London, UK
| |
Collapse
|
22
|
Elkhateeb SA, Mohammed EB, Meleka HA, Ismail AAE. Postmortem computed tomography and autopsy for detection of lesions and causes of death in gunshot injury cases: a comparative study. EGYPTIAN JOURNAL OF FORENSIC SCIENCES 2018. [DOI: 10.1186/s41935-018-0078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
23
|
Lewis C, Hill M, Arthurs OJ, Hutchinson JC, Chitty LS, Sebire N. Health professionals' and coroners' views on less invasive perinatal and paediatric autopsy: a qualitative study. Arch Dis Child 2018; 103:572-578. [PMID: 29438963 PMCID: PMC5965355 DOI: 10.1136/archdischild-2017-314424] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess health professionals' and coroners' attitudes towards non-minimally and minimally invasive autopsy in the perinatal and paediatric setting. METHODS A qualitative study using semistructured interviews. Data were analysed thematically. RESULTS Twenty-five health professionals (including perinatal/paediatric pathologists and anatomical pathology technologists, obstetricians, fetal medicine consultants and bereavement midwives, intensive care consultants and family liaison nurses, a consultant neonatologist and a paediatric radiologist) and four coroners participated. Participants viewed less invasive methods of autopsy as a positive development in prenatal and paediatric care that could increase autopsy rates. Several procedural and psychological benefits were highlighted including improved diagnostic accuracy in some circumstances, potential for faster turnaround times, parental familiarity with imaging and laparoscopic approaches, and benefits to parents and faith groups who object to invasive approaches. Concerns around the limitations of the technology such not reaching the same levels of certainty as full autopsy, unsuitability of imaging in certain circumstances, the potential for missing a diagnosis (or misdiagnosis) and de-skilling the workforce were identified. Finally, a number of implementation issues were raised including skills and training requirements for pathologists and radiologists, access to scanning equipment, required computational infrastructure, need for a multidisciplinary approach to interpret results, cost implications, equity of access and acceptance from health professionals and hospital managers. CONCLUSION Health professionals and coroners viewed less invasive autopsy as a positive development in perinatal and paediatric care. However, to inform implementation a detailed health economic analysis and further exploration of parental views, particularly in different religious groups, are required.
Collapse
Affiliation(s)
- Celine Lewis
- North East Thames Regional Genetics Service, Great Ormond Street Hospital, NHS Foundation Trust, London, UK,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Melissa Hill
- North East Thames Regional Genetics Service, Great Ormond Street Hospital, NHS Foundation Trust, London, UK,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Owen J Arthurs
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK,Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - John C Hutchinson
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK,Department of Histopathology, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Lyn S Chitty
- North East Thames Regional Genetics Service, Great Ormond Street Hospital, NHS Foundation Trust, London, UK,Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK
| | - Neil Sebire
- Genetics and Genomic Medicine, The UCL Great Ormond Street Institute of Child Health, London, UK,Department of Histopathology, Great Ormond Street Hospital For Children NHS Trust, London, UK
| |
Collapse
|
24
|
Harty MP, Harcke HT, Gould SW, Sukula-Perlman A. Pulmonary embolus as cause of death in an adolescent: demonstration on postmortem CT. Pediatr Radiol 2018; 48:745-748. [PMID: 29243077 DOI: 10.1007/s00247-017-4041-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/28/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
Abstract
Computed tomography (CT) is widely accepted in adult forensic death investigations (determination of cause and manner of death) but is only beginning to play a larger role in the cause of death determination in infants and children. We present a case of an adolescent with nephrotic syndrome who sustained cardiac arrest and died in the emergency department. A postmortem CT was requested by the state Office of the Medical Examiner as part of the medicolegal death investigation. Postmortem CT showed a saddle pulmonary embolus that was confirmed on conventional autopsy, demonstrating a natural manner of death.
Collapse
Affiliation(s)
- Mary P Harty
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.
| | - H Theodore Harcke
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | - Sharon W Gould
- Department of Medical Imaging, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA
| | | |
Collapse
|
25
|
Graziani G, Tal S, Adelman A, Kugel C, Bdolah-Abram T, Krispin A. Usefulness of unenhanced post mortem computed tomography - Findings in postmortem non-contrast computed tomography of the head, neck and spine compared to traditional medicolegal autopsy. J Forensic Leg Med 2018; 55:105-111. [PMID: 29494949 DOI: 10.1016/j.jflm.2018.02.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/25/2018] [Accepted: 02/19/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION/BACKGROUND Post-mortem CT (PMCT) is becoming an essential tool available to forensic pathologists worldwide, but its validity with respect to evidence for legal purposes still requires more comprehensive large-scale studies, comparing PMCT to autopsy. This article compares PMCT and autopsy findings of the head, neck, and spine during a period of five years. MATERIALS AND METHODS The study included 203 cases for which both autopsy and PMCT were performed. All relevant findings were extracted from the reports and divided into 30 categories based on anatomical location and tissue characteristics. Data were evaluated quantitatively in a binary fashion. RESULTS/FINDINGS A high level of agreement was noted for skull fractures, intraventricular- and subarachnoid hemorrhages, bullet trajectories, and intracranial shrapnel. A fair correlation was demonstrated for brain atrophy or herniation, and findings in the facial soft tissues. PMCT had higher sensitivity to brain edema, presence of gas in tissues or cavities, and findings in the spinal column and spinal canal, whereas autopsy better demonstrated pathologies in the brain tissue, hemorrhages in the neck and fractures of the larynx and hyoid bone. A relatively low correlation was noted for subdural and epidural hematomata. CONCLUSIONS/INTERPRETATION For several locations, structures, and specific findings in the head, neck and spine, autopsy remains indispensable. However, PMCT better demonstrated some findings in locations that are difficult to access by autopsy, or structures that might be damaged due to autopsy procedure. For the examinations of these, PMCT may in specific cases serve as an alternative to autopsy. Generally, however, due to the vast and fundamental differences that distinguish each case from the next, and the different purposes that autopsy may serve, we propose that the decision as to which method (or a combination of both) should be used, be made according to the circumstances and expected findings of each case.
Collapse
Affiliation(s)
- Gil Graziani
- Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Sigal Tal
- Radiology Department, Assaf Harofeh Medical Center, Zerifin 70300, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Adi Adelman
- Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Chen Kugel
- The National Institute of Forensic Medicine, 67 Ben Zvi Rd., Tel-Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | - Alon Krispin
- The National Institute of Forensic Medicine, 67 Ben Zvi Rd., Tel-Aviv, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Israel.
| |
Collapse
|
26
|
The value of postmortem computed tomography in paediatric natural cause of death: a Dutch observational study. Pediatr Radiol 2017; 47:1514-1522. [PMID: 28681231 PMCID: PMC5608837 DOI: 10.1007/s00247-017-3911-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/01/2017] [Accepted: 05/22/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postmortem CT is a relatively new field of interest within paediatric radiology. This paper focusses on its value in cases of unexpected natural death. OBJECTIVE We report on an observational Dutch study regarding the value of postmortem CT in children with an assumed natural unexpected death because postmortem CT is part of the Dutch NODO (additional investigations of cause of death) procedure. MATERIALS AND METHODS We included consecutive children who fulfilled criteria for the NODO procedure and were therefore referred to one of the centres for the procedure. Postmortem CT was performed in all cases and skeletal survey was performed in all children ages <5 years. The cause of death was defined in a consensus meeting. RESULTS We included a total of 54 children (30 boys, median age 1.1 years, and 24 girls, median age 0.8 years). A definitive cause of death was established in 38 cases. In 7 cases the cause of death could be identified on postmortem CT. In 7 cases imaging findings were clinically relevant but did not lead to a cause of death. In the remaining 40 cases postmortem CT did not add to the diagnostic workup. CONCLUSION Our study shows that in a group of children who unexpectedly died of an assumed natural cause of death and in whom a cause of death was found at autopsy, postmortem CT detected the cause of death in a minority of cases (12.9%). In the majority of cases (74.1%) postmortem CT did not add value in diagnosing the cause of death.
Collapse
|
27
|
Multiphase Postmortem Computed Tomography Angiography in Pediatrics: A Case Report. Am J Forensic Med Pathol 2016; 36:239-44. [PMID: 26280883 DOI: 10.1097/paf.0000000000000189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postmortem imaging techniques, especially postmortem computed tomography, have become integral tools in forensic investigations. Multiphase postmortem computed tomography angiography (MPMCTA) visualizes the vascular system in detail and makes it possible to evaluate the perfusion of even the smallest vessels. Although the technique has been well described for adults, no pediatric cases have been reported and no pediatric protocol has been established for this type of investigation. We present the case a 7-year-old child for which we used a previously described MPMCTA protocol and adapted values of perfusion, with the same technical equipment as for adult cases. Our main objective was to propose a perfusion protocol adapted for the investigation of infants and children. Moreover, we discuss both the difficulties that we encountered and possible ways to further improve the investigation of pediatric cases by MPMCTA.
Collapse
|
28
|
Performance of post-mortem CT compared to autopsy in children. Int J Legal Med 2016; 130:1089-1099. [PMID: 27221535 DOI: 10.1007/s00414-016-1370-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Radiological techniques such as non-enhanced post-mortem computed tomography (PMCT) play an increasingly important role in death investigations, especially in cases of non-medicolegal context of death, where the consent of the next of kin is required to perform autopsy. Such consent is often difficult to obtain for deceased children, and radiological methods may be an acceptable alternative. The aim of our study was to evaluate the performance of PMCT explorations compared to medicolegal conventional autopsies in children and its potential usefulness in non-medicolegal situations. METHODS We retrospectively reviewed a group of 26 children aged 0-12 years who died of different causes, which were investigated by both conventional autopsy and PMCT. We compared the findings extracted from radiological and autopsy reports. All findings were grouped according to their importance with respect to cause of death and to the anatomical structure they covered: organs, vascular system, soft tissue, and skeletal system. RESULTS A significantly larger number of findings were detected by autopsy compared to PMCT. Autopsy proved to be superior to PMCT, notably at detecting organ, soft tissue, and vascular findings, while PMCT was superior at detecting bone findings. However, no statistically significant differences were found between the methods concerning the essential findings used to define the cause of death. CONCLUSIONS In children, PMCT was less sensitive than conventional autopsy for detecting general findings. However, most essential findings were detected by both methods. PMCT was superior to autopsy for the detection of bone lesions in children. ADVANCES IN KNOWLEDGE Up to today, very rare literature exists concerning PMCT in children, especially in a forensic setting. This article investigates the advantages and limitations of PMCT compared to autopsy in a unique study group and discusses possibilities for future developments.
Collapse
|
29
|
Arthurs OJ, Guy A, Kiho L, Sebire NJ. Ventilated postmortem computed tomography in children: feasibility and initial experience. Int J Legal Med 2015; 129:1113-20. [PMID: 25904077 DOI: 10.1007/s00414-015-1189-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/07/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Ventilated postmortem computed tomography (vPMCT) is associated with improved pulmonary imaging compared to standard PMCT in adults. We aimed to evaluate the feasibility of performing ventilated PMCT in children. METHODS Postmortem thoracic CT was performed before (PMCT) and after ventilation (vPMCT). We used a range of mouthpieces, including endotracheal tubes, bag and mask and laryngeal mask airway (LMA). Hounsfield units of the lungs at PMCT were measured for normal and abnormal lung areas, before and after ventilation. All patients underwent full conventional autopsy and histology. RESULTS Twelve patients underwent ventilated PMCT, median age 52 days (range 3-304 days). Ventilated PMCT provided diagnostic lung images in all 12 cases, compared to only three unventilated PMCT examinations (p < 0.005). In all cases, ventilated PMCT improved the image quality of aerated lungs irrespective of the method used. Average lung Hounsfield units decreased significantly with ventilation from pre-vPMCT values (-134.1 ± 215.1 vs post-vPMCT -531.8 ± 190.1; p < 0.001). LMA with continuous positive pressure ventilation subjectively provided the best results. CONCLUSION Ventilated PMCT significantly improves lung aeration in children and can aid recognition of areas of abnormality in paediatric lungs. Such advances will improve accuracy and uptake of imaging-assisted autopsies in children.
Collapse
Affiliation(s)
- Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK,
| | | | | | | |
Collapse
|
30
|
Non-specific post-mortem modifications on whole-body post-mortem computed tomography in sudden unexpected death in infancy. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jofri.2015.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|