Abstract
Objective. To determine the accuracy of postmortem computed tomography (PMCT) for the assessment of causes in nontraumatic deaths in children. Study Design. We enrolled cases of nontraumatic deaths of infants and children who underwent PMCT at a single center. The presumed cause of death determined by PMCT was prospectively compared with the clinical and pathological diagnoses of deaths. Results. Thirty-eight cases were enrolled for analysis. Among them, seven cases also underwent conventional medical autopsy. PMCT revealed an identifiable cause of death in accordance with the clinical diagnosis of death in 16 cases of the 38 cases (the concordance rate was 42%) and in accordance with the autopsy cause of death in four of the seven autopsy cases (the concordance rate was 57%). Among eight cases with unknown cause of death by clinical diagnosis, four cases (50%) were identified with cardiac tamponade as a cause of death (one case) and intracranial hemorrhage suggesting abuse (3 cases). Conclusions. PMCT seems to be a promising technique that might serve as a substitute for conventional medical autopsy and give us the complementary information to clinical diagnoses particularly in cases of child abuse. Larger multicenter trials are worthwhile to validate the general feasibility of PMCT.
Highlights
Autopsy is considered the reference standard for postmortem evaluations held to identify the cause of death while the decline of autopsies among adults in most developed countries in the latter half of the 20th century and beyond is well established [1].In children with unexpected death, a systematic conventional autopsy, with macroscopic and histological investigations, is usually offered to the parents of a child or infant who died as parental informed consent is required for an autopsy except in the case of forensic investigation
Le Blanc-Louvry et al suggested that the concordance between postmortem computed tomography (PMCT) and autopsy is almost perfect in determining the cause of death, and PMCT could be considered as effective as a forensic standard autopsy in determining the cause of death in certain traumatic events [7]; Roberts et al found that PMCT was even more accurate imaging technique than postmortem MRI for determining the cause of death compared to traditional autopsy [5]
The percentage agreement on the cause of nontraumatic death in infants and children made by clinical diagnosis and by PMCT was 42% and that for the cause made by PMCT and by conventional autopsy was 57%
Summary
Autopsy is considered the reference standard for postmortem evaluations held to identify the cause of death while the decline of autopsies among adults in most developed countries in the latter half of the 20th century and beyond is well established [1].In children with unexpected death, a systematic conventional autopsy, with macroscopic and histological investigations, is usually offered to the parents of a child or infant who died as parental informed consent is required for an autopsy except in the case of forensic investigation. Autopsy is considered the reference standard for postmortem evaluations held to identify the cause of death while the decline of autopsies among adults in most developed countries in the latter half of the 20th century and beyond is well established [1]. A global trend of declining pediatric autopsy rates has been reported as well as in adults because of the emotional, cultural, or religious reasons for refusing autopsy [2, 3]. Failure to obtain the parental informed consent for a pediatric autopsy occurs frequently in Japan, mostly for emotional reasons given by the parents. Several studies have reported the use of postmortem imaging in order to identify the cause of death in adults [5,6,7,8]. The reason for the usability of PMCT is as follows: the major discrepancy rate compared with autopsy was significantly higher for MRI than for PMCT; CT provides better spatial resolution than
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
