Computed Tomography Autopsy: A 12 Year Experience at a Community Trauma Center

Abstract

Introduction: Post-mortem computed tomography (CT) has failed to gain traction in the United States. CT is readily available and well understood by all surgeons who take care of trauma patients. To our knowledge, there are no published reports on the routine use of post-mortem CT for performance improvement. Methods: Beginning in 2008, trauma patients who expire in our ED have undergone whole body non-contrast CT. These studies are reviewed immediately to evaluate our resuscitation efforts. They are all presented at our monthly trauma conference. Results: Seventy-two patients had CT autopsies and 35 of these had autopsies (47%): 66% were blunt and 33% were penetrating injuries. Probable cause of death was established by CT in 70 of the patients and 2 appeared to have non-fatal injuries suggesting a medical cause. Fifty-six of sixty-two (90%) chest tubes placed were in functional position; 4 were in the subcutaneous tissue, 1 in the lung and 1 below the diaphragm. Of the 31 needle decompressions present on CT, 27 (88%) did not reach the pleura, including one death from tension pneumothorax. One needle, from a lateral attempt, was in the liver. Seventy patients had airways placed; of these, one ET tube was in the right main stem bronchus and one king airway was in the subcutaneous space of the hypopharynx. Conclusion: Post-mortem CT is easy to obtain, carries no risk of communicable disease and is free of cultural objections. The information obtained is the only practical way to assess our efforts in these most critically injured patients.