Postmortem Computed Tomography, “CATopsy”, Predicts Cause of Death in Trauma Patients

Abstract

The autopsy remains the gold standard for evaluating traumatic deaths. The number of autopsies performed has declined dramatically. This study examines whether postmortem computed tomography ("CATopsy") can be used to determine cause of death in trauma patients. Patients who presented to the trauma service and subsequently died within the first 24 hours of their hospitalization were prospectively enrolled. Any patient who underwent a major invasive procedure within this time frame was excluded. After pronouncement of death, each patient had a CATopsy performed, which was a noncontrast whole body scan. The patient then underwent an autopsy. These results were compared with those generated by the CATopsy. There were 12 patients enrolled in the study; average Injury Severity Scores was 33.5 +/- 19.0. In 10 of the 12 cases (83%), the CATopsy successfully indicated cause of death when compared with the autopsy. Seven of the 12 (58%) CATopsies demonstrated air in various parts of the circulatory system, including the heart in four cases. Five of the 12 (42%) patients had clinically significant findings (including the presence of an esophageal intubation) noted on the CATopsy not previously identified on any radiographic studies or on the autopsy. These findings were addressed as part of our performance improvement process. This study suggests that a postmortem imaging test, a CATopsy, can be used to determine cause of death in trauma patients. Beyond offering a noninvasive alternative to autopsy, it provides similar information to that provided in postmortem examination and may be used in trauma performance improvement activities.