Post-mortem computed tomography improves completeness of the trauma registry: a single institution experience
To describe our institutional experience with post-mortem computed tomography (PMCT) and its impact on decedent injury severity score (ISS) and to assess the adequacy of emergently placed support medical devices.
Over a 5-year period, patients who died at or soon after arrival and have physical exam findings inconsistent with death were candidates for inclusion. Whole body CT was performed without contrast with support medical devices left in place. ISS was calculated with and without the PMCT findings. PMCT results were compared to autopsy findings, if performed. The location of support medical devices was documented.
A total of 38 decedents underwent PMCT, including 53.1% males and a mean age of 42.0 years. Pre-PMCT ISS based on physical exam findings alone was 5.2 (range 0–25), including 16 with ISS = 0. Post-PMCT ISS using the additional imaging data was 50.3 (range 21–75), including 15 with ISS = 50 or greater. Nearly half (47.4%) had at least one support medical device that was either malpositioned or suboptimally positioned, including 26.3% with malpositioned airway devices, 10.3% with malpositioned intra-osseous catheters, and 100% with malpositioned decompressive needle thoracotomies.
PMCT adds value in identifying injuries that otherwise may have gone undetected in lieu of a formal autopsy, thus creating a more complete trauma registry. The identification of malpositioned support lines and tubes allows for educational feedback to the first responders and trainees. Institutions with a low formal autopsy rate for trauma victims may benefit from developing a PMCT program.
KeywordsTrauma Mortality Post-mortem CT
Compliance with ethical standards
Conflict of interest
Scott D. Steenburg, MD
- International Business Machines – Institutional joint study agreement
- Department of the Army – research grant support (Federal award number: W81XWH-16-2-0060)
For all other authors, there are no conflicts of interest.
- 1.ACS TQIP Aggregate Report: Spring 2016. National Trauma Institute. http://www.nationaltraumainstitute.org/home/trauma_statistics.html. Accessed 12/21/2017
- 9.Hodgson NF, Stewart TC, Girotti MJ (2000) Autopsies and death certification in deaths due to blunt trauma: what are we missing? Can J Surg 43:130–136Google Scholar
- 17.Suh RD, Genshaft SJ, Kirsch J, Kanne JP, Chung JH, Donnelly EF, Ginsburg ME, Heitkamp DE, Henry TS, Kazerooni EA, Ketai LH, McComb BL, Ravenel JG, Saleh AG, Shah RD, Steiner RM, Mohammed TL (2015) ACR Appropriateness Criteria Intensive Care Unit Patients. J Thorac Imaging 30(6):W63–W65CrossRefGoogle Scholar
- 21.Leidel BA, Kirchhoff C, Bogner V, Stegmaier J, Mutschler W, Kanz K-G, Braunstein V (2009) Is the intraosseous access route fast and efficacious compared to conventional central venous catheterization in adult patients under resuscitation in the emergency department? A prospective observational pilot study. Patient Saf Surg 3(1):24CrossRefGoogle Scholar
- 23.Wernick B, Hon HH, Muband RN, Cipriano A, Hughes R, Rankin DD, Evans DC, Burdeind WR Jr, Hoey BA, Cipolla J, Galwankar SC, Papadimos TJ, Stawicki SP, Firstenberg MS (2015) Complications of needle thoracostomy: a comprehensive clinical review. Int J Crit Illn Inj Sci 5(3):160–169CrossRefGoogle Scholar
- 25.Ball CG, Wyrzykowski AD, Kirkpatrick AW, Dente CJ, Nicholas JM, Salomone JP, Rozycki GS, Kortbeek JB, Feliciano DV (2010) Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg 53(3):184–188Google Scholar
- 28.Levy G, Goldstein L, Blachar A, Apter S, Barenboim E, Bar-Dayan Y, Shamis A, Atar E (2007) Postmortem computed tomography in victims of military air mishaps: radiological-pathological correlation of CT findings. Isr Med Assoc J 9:699–702Google Scholar
- 29.Thali MJ, Yen K, Schweitzer W, Vock P, Boesch C, Ozdoba C, Schroth G, Ith M, Sonnenschein M, Doernhoefer T, Scheurer E, Plattner T, Dirnhofer R (2003) Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)—a feasibility study. J Forensic Sci 48:386–403Google Scholar