Does Postmortem Imaging Provide Additional Findings After Unexpected Deaths in Infants and Children?

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.