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Efficacy of postmortem CT and tissue sampling in establishing the cause of death in clinical practice: a prospective observational study
  1. Max Guillaume Mentink1,
  2. Bart G H Latten2,3,
  3. Frans C H Bakers1,
  4. Casper Mihl1,4,
  5. Faysal Benali1,
  6. Patty J Nelemans5,
  7. Roger J M W Rennenberg6,
  8. Richard P Koopmans6,
  9. Dennis C J J Bergmans7,
  10. Bela Kubat2,
  11. Paul A M Hofman1
  1. 1Radiology & Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
  2. 2Pathology, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
  3. 3Pathology, Netherlands Forensic Institute, Den Haag, Netherlands
  4. 4CARIM school for Cardiovascular Diseases, Maastricht University, Maastricht, Netherlands
  5. 5Epidemiology, Maastricht University, Maastricht, Netherlands
  6. 6Internal Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
  7. 7Intensive Care, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
  1. Correspondence to Max Guillaume Mentink, Radiology & Nuclear Medicine, Maastricht Universitair Medisch Centrum+, Maastricht, Limburg, Netherlands; maxmentink92{at}gmail.com

Abstract

Aims The aim of this study is to evaluate whether agreement with autopsy-determined cause of death (COD) increases by use of postmortem CT (PMCT) or PMCT in combination with postmortem sampling (PMS), when compared with clinical assessment only.

Methods This prospective observational study included deceased patients from the intensive care unit and internal medicine wards between October 2013 and August 2017. The primary outcome was percentage agreement on COD between the reference standard (autopsy) and the alternative postmortem examinations (clinical assessment vs PMCT or PMCT+PMS). In addition, the COD of patient groups with and without conventional autopsy were compared with respect to involved organ systems and pathologies.

Results Of 730 eligible cases, 144 could be included for analysis: 63 underwent PCMT without autopsy and 81 underwent both PMCT and autopsy. Agreement with autopsy-determined COD was significantly higher for both PMCT with PMS (42/57, 74%), and PMCT alone (53/81, 65%) than for clinical assessment (40/81, 51%; p=0.007 and p=0.03, respectively). The difference in agreement between PMCT with PMS and PMCT alone was not significant (p=0.13). The group with autopsy had a significantly higher prevalence of circulatory system involvement and perfusion disorders, and a lower prevalence of pulmonary system involvement.

Conclusion PMCT and PMS confer additional diagnostic value in establishing the COD. Shortcomings in detecting vascular occlusions and perfusion disorders and susceptibility to pulmonary postmortem changes could in future be improved by additional techniques. Both PMCT and PMS are feasible in clinical practice and an alternative when autopsy cannot be performed.

  • Autopsy
  • Image Processing, Computer-Assisted
  • Image-Guided Biopsy
  • DEATH
  • Pathology Department, Hospital

Data availability statement

Data are available on reasonable request. Data can be shared at reasonable request.

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Data availability statement

Data are available on reasonable request. Data can be shared at reasonable request.

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Footnotes

  • Handling editor Tahir S Pillay.

  • Contributors MGM and BGHL contributed equally to this paper. FCHB, CM, DCJJB, RJMWR, PAMH and BK were responsible for study concept and design. Data acquisition was performed by MGM, BGHL, FCHB, CM and FB. MGM and PJN performed the data analysis and interpretation. MGM and BGHL were responsible for the literature search and generation of figures. All authors were involved in writing the paper and had final approval of the submitted and published versions. MGM is the Guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.