Could pre-mortem computerised tomography scans reduce the need for coroner's post-mortem examinations?

Area of Science:

• Medical Imaging
• Forensic Pathology
• Clinical Auditing

Background:

• Post-mortem examinations can cause significant distress to grieving families.
• Accurate determination of the cause of death is crucial for public health and legal purposes.

Purpose of the Study:

• To evaluate the potential of pre-mortem computerised tomography (CT) scanning to replace post-mortem examinations.
• To assess if CT scanning can maintain or improve the accuracy of cause-of-death certification.

Main Methods:

• Retrospective audit of 100 consecutive cases requiring a coroner's post-mortem due to unknown cause of death.
• Four senior clinicians reviewed case notes to determine if pre-mortem CT would have been sufficient for death certification.
• Assessed concordance between post-mortem findings and clinical history.

Main Results:

• Pre-mortem CT scanning was feasible in 90% of cases.
• CT scans would have provided the cause of death in 66% of feasible cases.
• Significant discrepancies were found between clinical events and post-mortem findings in 30% of cases, with vital information missed on death certificates in 26%.

Conclusions:

• Pre-mortem CT scanning, combined with senior clinician involvement, can enhance accuracy in determining the cause of death.
• CT may obviate the need for post-mortems in select cases, reducing family distress.
• Ensuring availability of clinical notes and clinician attendance at post-mortems is vital for accurate death certification when post-mortems are necessary.