Postmortem CT compared to autopsy in children; concordance in a forensic setting

Area of Science:

• Forensic pathology
• Medical imaging
• Pediatric medicine

Background:

• Forensic autopsies are crucial for determining the cause of death in suspected non-natural fatalities.
• Postmortem CT (PMCT) is increasingly used as a complementary tool in forensic investigations.
• Assessing the accuracy of PMCT in pediatric cases is essential for its effective application.

Purpose of the Study:

• To evaluate the diagnostic accuracy of PMCT in identifying the cause of death in children.
• To compare PMCT findings with autopsy results in pediatric forensic cases.
• To determine the concordance between PMCT and autopsy for natural versus unnatural causes of death.

Main Methods:

• Retrospective analysis of pediatric forensic autopsies with available PMCT data.
• Independent cause of death scoring by a radiologist and a pathologist.
• Classification of cause of death using ICD-10 and institutional categories.

Main Results:

• Of 174 autopsies, 98 underwent PMCT; concordance with autopsy was 70% for cause category and 67-72% for specific cause.
• PMCT showed higher agreement in unnatural deaths (59-67%) compared to natural deaths (0%).
• PMCT failed to identify a cause of death in 98% of cases where autopsy also found no cause.

Conclusions:

• Pediatric PMCT is effective in identifying the majority of unnatural causes of death.
• PMCT does not provide new diagnoses when autopsy reveals no cause of death.
• The diagnostic accuracy of PMCT for natural deaths is limited.