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Use of Post-Mortem Computed Tomography During the COVID-19 Pandemic: The Malaysian Experience
Mansharan Kaur Chainchel Singh1,2,3, Mohamad Helmee Mohd Noor3,4, Mohamad Azaini Ibrahim3
1Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Selangor, Malaysia.
Insights
Post-mortem CT scans (PMCT) effectively determined the cause of death in 78.7% of cases during the COVID-19 pandemic. This imaging technique aids in identifying cause of death without full autopsy, enhancing safety for mortuary staff.
Area of Science:
- Forensic Radiology
- Pathology
- Public Health
Background:
- The COVID-19 pandemic posed significant risks to healthcare workers, including those in mortuaries.
- The need for alternative methods to determine cause of death (COD) without full autopsy became critical.
- Post-mortem imaging modalities were explored as a safer alternative.
Purpose of the Study:
- To evaluate the effectiveness of post-mortem computed tomography (PMCT) in determining the cause of death (COD) during a pandemic.
- To assess the agreement between PMCT findings and conventional autopsy results for COD determination.
- To investigate the utility of PMCT as a limited autopsy procedure in a pandemic setting.
Main Methods:
- A cross-sectional study involving 172 deceased individuals with suspected or unknown COVID-19 status.
- Analysis of post-mortem computed tomography (PMCT) images by forensic radiologists.
- Comparison of PMCT findings with conventional autopsy results and cause of death certification by forensic pathologists.
Main Results:
- Post-mortem CT scans (PMCT) showed agreement with the certified cause of death in 78.7% of cases.
- In 63.9% of agreeing cases, PMCT was the primary method for determining COD, supplemented by external examination and COVID-19 testing.
- This highlights the significant role of imaging in COD determination when full autopsy is not feasible.
Conclusions:
- Post-mortem computed tomography (PMCT) is a valuable tool for determining the cause of death in pandemic situations.
- PMCT can serve as a complementary method to medicolegal autopsies, offering crucial information safely.
- The use of PMCT enhances the safety of mortuary healthcare workers by reducing exposure risks.
Background:
COVID-19 was declared a pandemic by the World Health Organization (WHO). COVID-19 is highly contagious, making it a threat to healthcare workers, including those working in mortuaries. Therefore, it is important to determine if the cause of death (COD) could be identified using limited autopsy, diagnostic tests and post-mortem imaging modalities instead of full autopsy. This study aims to examine the effectiveness of post-mortem imaging, specifically post-mortem computed tomography (PMCT) at determining the COD during a pandemic.
Methods:
This cross-sectional study included 172 subjects with suspected or unknown COVID-19 status brought in dead to the institute's mortuary during the pandemic in Malaysia. PMCT images reported by forensic radiologists and their agreement with conventional autopsy findings by forensic pathologists regarding COD were analysed to look at the effectiveness of PMCT in determining COD during a pandemic.
Results:
Analysis showed that 78.7% (133) of cases reported by forensic radiologists concurred with the COD certified by forensic pathologists. Of these cases, 85 (63.9%) had undergone only external examination and real-time reverse transcriptase polymerase chain reaction (rRT-PCR) COVID-19 testing, meaning that imaging was the sole method used to determine the COD besides history from available medical records and the investigating police officer.
Conclusion:
PMCT can be used as a complement to medicolegal autopsies in pandemic contexts, as it provides significant information on the possible COD without jeopardising the safety of mortuary health care workers.
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