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Emergency Radiology

, Volume 26, Issue 1, pp 5–13 | Cite as

Post-mortem computed tomography improves completeness of the trauma registry: a single institution experience

  • Scott D. SteenburgEmail author
  • Tracy Spitzer
  • Amy Rhodes
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Trauma Mortality Post-mortem CT 

Notes

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.

References

  1. 1.
    ACS TQIP Aggregate Report: Spring 2016. National Trauma Institute. http://www.nationaltraumainstitute.org/home/trauma_statistics.html. Accessed 12/21/2017
  2. 2.
    Baker SP, O’Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196CrossRefGoogle Scholar
  3. 3.
    Copes WS, Champion HR, Sacco WJ, Lawnick MM, Keast SL, Bain LW (1988) The injury severity score revisited. J Trauma 28(1):69–77CrossRefGoogle Scholar
  4. 4.
    Scholing M, Saltzherr TP, Fung Kon Jin PHP, Ponsen KJ, Reitsma JB, Lameris JS, Goslings JC (2009) The value of postmortem computed tomography as an alternative for autopsy in trauma victims: a systematic review. Eur Radiol 19:2333–2341CrossRefGoogle Scholar
  5. 5.
    Dirnhofer R, Jackowski C, Vock P, Potter K, Thali MJ (2006) VIRTOPSY: minimally invasive, imaging-guided virtual autopsy. Radiographics 26(5):1305–1333CrossRefGoogle Scholar
  6. 6.
    Hoey BA, Cipolla J, Grossman MD, McQuay N, Shukla PR, Stawicki SP, Stehly C, Hoff WS (2008) Postmortem computed tomography, “CATopsy”, predicts cause of death in trauma patients. J Trauma 63:979–985CrossRefGoogle Scholar
  7. 7.
    O’Grady G (2003) Death of the teaching autopsy. BMJ 327:802–803CrossRefGoogle Scholar
  8. 8.
    Ong AW, Cohn SM, Cohn KA, Jaramillo DH, Parbhu R, McKenney MG, Barquist ES, Bell MD (2002) Unexpected findings in trauma patients dying in the intensive care unit: results of 153 consecutive autopsies. J Am Coll Surg 194:401–406CrossRefGoogle Scholar
  9. 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
  10. 10.
    Grabherr S, Egger C, Vilarino R, Campana L, Jotterand M, Dedouit F (2017) Modern post-mortem imaging: an update on recent developments. Forensic Sciences Research 2(2):52–64CrossRefGoogle Scholar
  11. 11.
    Krantz P, Holtas S (1983) Postmortem computed tomography in a diving fatality. J Comput Assist Tomogr 7:132–134CrossRefGoogle Scholar
  12. 12.
    Jeffery AJ (2010) The role of computed tomography in adult post-mortem examinations: an overview. Diagn Histopathol 16:546–551CrossRefGoogle Scholar
  13. 13.
    Donchin Y, Rivkind AI, Bar-Ziv J, Hiss J, Almog J, Drescher M (1994) Utility of postmortem computed tomography in trauma victims. J Trauma 37:552–555CrossRefGoogle Scholar
  14. 14.
    Jalalzadeh H, Giannakopoulos GF, Berger F, Fronczek F, van de Goot FRW, Reijnders UJ, Zuidema WP (2015) Post-mortem imaging compared with autopsy in trauma victims - a systematic review. Forensic Sci Int 257:29–48CrossRefGoogle Scholar
  15. 15.
    Roberts IS, Benamore RE, Benbow EW, Lee SH, Harris JN, Jackson A, Mallett S, Patankar T, Peebles C, Rootbottom C, Traill ZC (2012) Post-mortem imaging as an alternative to autopsy in the diagnosis of adult deaths: a validation study. Lancet 379(9811):136–142CrossRefGoogle Scholar
  16. 16.
    Lotan E, Portnoy O, Konen E, Simon D, Guranda L (2015) The role of early postmortem CT in the evaluation of support-line misplacement in patients with severe trauma. Am J Roentgenol 204:3–7CrossRefGoogle Scholar
  17. 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
  18. 18.
    Brunel W, Coleman DL, Schwartz DE, Peper E, Cohen NH (1989) Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position. Chest 96(5):1043–1045CrossRefGoogle Scholar
  19. 19.
    Katz SH, Falk JL (2001) Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann Emerg Med 37(1):32–37CrossRefGoogle Scholar
  20. 20.
    Jemmett ME, Kendal KM, Fourre MW, Burton JH (2003) Unrecognized misplacement of endotracheal tubes in a mixed urban to rural emergency medical services setting. Acad Emerg Med 10(9):961–965CrossRefGoogle Scholar
  21. 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
  22. 22.
    Maybauer MO, Geisser W, Wolff H, Maybauer DM (2012) Incidence and outcome of tube thoracostomy positioning in trauma patients. Prehosp Emerg Care 16:237–241CrossRefGoogle Scholar
  23. 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
  24. 24.
    Eckstein M, Suyehara D (1998) Needle thoracostomy in the prehospital setting. Prehosp Emerg Care 2(2):132–135CrossRefGoogle Scholar
  25. 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
  26. 26.
    Aghayev E, Christe A, Sonnenschein M, Yen K, Jackowski C, Thali MJ, Dirnhofer R, Vock P (2008) Postmortem imaging of blunt chest trauma using CT and MRI: comparison with autopsy. J Thorac Imaging 23:20–27CrossRefGoogle Scholar
  27. 27.
    Levy AD, Abbott RM, Mallak CT, Getz JM, Harcke HT, Champion HR, Pearse LA (2006) Virtual autopsy: preliminary experience in high-velocity gunshot wound victims. Radiology 240(2):522–528CrossRefGoogle Scholar
  28. 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. 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
  30. 30.
    Yen K, Lovblad KO, Scheurer E, Ozdoba C, Thali MJ, Aghayev E, Jackowski C, Anon J, Frickey N, Zwygart K, Weis J, Dirnhofer R (2007) Post-mortem forensic neuroimaging: correlation of MSCT and MRI findings with autopsy results. Forensic Sci Int 173:21–35CrossRefGoogle Scholar
  31. 31.
    Smith AB, Lattin GE Jr, Berran P, Harcke HT (2012) Common and expected postmortem CT observations involving the brain: mimics of antemortem pathology. AJNR Am J Neuroradiol 33:1387–1391CrossRefGoogle Scholar
  32. 32.
    Jackowski C, Sonnenschein M, Thali MJ, Aghayev E, von AG, Yen K, Dirnhofer R, Vock P (2005) Virtopsy: postmortem minimally invasive angiography using cross section techniques—implementation and preliminary results. J Forensic Sci 50:1175–1186CrossRefGoogle Scholar
  33. 33.
    Ross SG, Bollinger SA, Ampanozi G, Oesterhellweg L, Thali MJ, Flach PM (2014) Postmortem CT angiography: capabilities and limitations in traumatic and natural causes of death. RadioGraphics 34(3):830–846CrossRefGoogle Scholar
  34. 34.
    Grabherr S, Grimm J, Dominguez A, Vanhaebost J, Mangin P (2014) Advances in post-mortem CT-angiography. Br J Radiol 87(1036):20130488CrossRefGoogle Scholar
  35. 35.
    Busardo FP, Frati P, Guglielmi G, Grilli G, Pinto A, Rotondao A, Panebianco V, Fineschi V (2015) Post mortem computed tomography and post mortem computed tomography angiography: a focused update. Radiol Med 120(9):810–823CrossRefGoogle Scholar

Copyright information

© American Society of Emergency Radiology 2018

Authors and Affiliations

  • Scott D. Steenburg
    • 1
    Email author
  • Tracy Spitzer
    • 2
  • Amy Rhodes
    • 1
  1. 1.Department of Radiology and Imaging Sciences, Division of Emergency RadiologyIndiana University School of Medicine and Indiana University Health Methodist HospitalIndianapolisUSA
  2. 2.Department of Trauma and Critical Care SurgeryIndiana University School of Medicine and Indiana University Health Methodist HospitalIndianapolisUSA

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