Abstract
BackgroundPostmortem CT is a relatively new field of interest within paediatric radiology. This paper focusses on its value in cases of unexpected natural death.ObjectiveWe report on an observational Dutch study regarding the value of postmortem CT in children with an assumed natural unexpected death because postmortem CT is part of the Dutch NODO (additional investigations of cause of death) procedure.Materials and methodsWe included consecutive children who fulfilled criteria for the NODO procedure and were therefore referred to one of the centres for the procedure. Postmortem CT was performed in all cases and skeletal survey was performed in all children ages <5 years. The cause of death was defined in a consensus meeting.ResultsWe included a total of 54 children (30 boys, median age 1.1 years, and 24 girls, median age 0.8 years). A definitive cause of death was established in 38 cases. In 7 cases the cause of death could be identified on postmortem CT. In 7 cases imaging findings were clinically relevant but did not lead to a cause of death. In the remaining 40 cases postmortem CT did not add to the diagnostic workup.ConclusionOur study shows that in a group of children who unexpectedly died of an assumed natural cause of death and in whom a cause of death was found at autopsy, postmortem CT detected the cause of death in a minority of cases (12.9%). In the majority of cases (74.1%) postmortem CT did not add value in diagnosing the cause of death.
Highlights
In 2013, in a population of 3,870,773 inhabitants younger than 20, 1,112 persons (0.29 per 1 million) died in the Netherlands [1]
Our study shows that in a group of children who unexpectedly died of an assumed natural cause of death and in whom a cause of death was found at autopsy, postmortem CT detected the cause of death in a minority of cases (12.9%)
In two of these cases the radiologic examination led to the abortion of the NODO procedure; these included one case of an epidural hematoma and one case of what appeared on conventional radiography and CT to be a linear skull fracture [11]
Summary
In 2013, in a population of 3,870,773 inhabitants younger than 20, 1,112 persons (0.29 per 1 million) died in the Netherlands [1]. Of the children who died in 2014, the majority (n=645) were younger than 1 year. These figures show that there is a low risk of death before the age of 20 years in the Netherlands. In these rare cases the cause of death should be thoroughly investigated to prevent further cases of early demise in case of genetic-based diseases or disorders. Determining cause of death can help parents in overcoming the grief of losing their child [2]. This paper focusses on its value in cases of unexpected natural death
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