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Does Postmortem Imaging Provide Additional Findings After Unexpected Deaths in Infants and Children?
Chelsey Yurkovich1, Dena Nazer, Ahmad Farooqi2
1From the Sparrow Hospital Emergency Medicine, Lansing.
Insights
Pediatric postmortem imaging (PMI) aids in diagnosing unexpected deaths in young children, revealing abuse in cases with normal physical exams. Adherence to guidelines for skeletal surveys and autopsies in infants needs improvement.
Area of Science:
- Forensic pathology
- Pediatric mortality
- Medical imaging
Background:
- Unexpected deaths in children under two require thorough investigation.
- Current guidelines recommend specific postmortem examinations, including skeletal surveys and autopsies, for infants.
Purpose of the Study:
- To evaluate the adherence to pediatric postmortem examination guidelines.
- To assess the utility of postmortem imaging (PMI) in identifying findings in unexpected pediatric deaths.
Main Methods:
- Retrospective study of unexpected deaths in children aged 0-2 years (2008-2018).
- Exclusion of known traumatic deaths and transfers after out-of-institution cardiopulmonary arrest.
- Collection of demographics, physical exam findings, and PMI results.
Main Results:
- 150 deaths analyzed; 85.3% were infants.
- Postmortem imaging was not performed in 13.3% and autopsy in 14.6%.
- PMI revealed additional findings in 34% of infants and 59.1% of older children, identifying abuse in 11 cases, including 3 with negative autopsies.
Conclusions:
- Adherence to American Academy of Pediatrics recommendations for skeletal surveys and autopsies in infant deaths was suboptimal.
- Postmortem imaging is valuable for uncovering additional findings in children up to 2 years old.
- PMI is particularly crucial for detecting physical abuse in infants with normal physical examination findings.
Methods:
We performed a retrospective study of unexpected deaths in children 2 years or younger between 2008 and 2018. Children with known traumatic deaths and those transferred after a cardiopulmonary arrest at an outside institution were excluded. We collected patient demographics, physical examination findings, and type of PMI performed along with their results.
Results:
We analyzed 150 deaths with majority (128; 85.3%) being infants. No PMI was performed in 20 children (13.3%). An autopsy was not performed in 22 children (14.6%). A skeletal survey and an autopsy were performed only in 72.6% (93/128) infants. PMI provided additional findings in 51 infants (34%) and 13 children (59.1%) aged 13 to 24 months. PMI identified abuse in 11 children with a negative physical examination result, 3 of whom had a negative autopsy.
Conclusions:
The American Academy of Pediatrics recommendations of performance of a skeletal survey and an autopsy were not adhered to after all infant deaths. PMI is useful in identification of additional findings in children 2 years or younger, especially those concerning for physical abuse in infants with a negative physical examination.
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