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Tue Apr 22 00:39:29 BST 2008

How about the idea of at least doing a post-mortem CXR or the so-called "CAT-opsy" - should we fight to institute that in lieu of the autopsies ? Dr. Mattox can you help with that ?

: J Trauma. 2007 Nov;63(5):979-85; discussion 985-6. Links
Postmortem computed tomography, "CATopsy", predicts cause of death in trauma patients.
Hoey BA, Cipolla J, Grossman MD, McQuay N, Shukla PR, Stawicki SP, Stehly C, Hoff WS.
St. Luke's Hospital, University of Pennsylvania Trauma Network, Bethlehem, PA 18015, USA. hoeyb at slhn.org
BACKGROUND: The autopsy remains the gold standard for evaluating traumatic deaths. The number of autopsies performed has declined dramatically. This study examines whether postmortem computed tomography ("CATopsy") can be used to determine cause of death in trauma patients. METHODS: Patients who presented to the trauma service and subsequently died within the first 24 hours of their hospitalization were prospectively enrolled. Any patient who underwent a major invasive procedure within this time frame was excluded. After pronouncement of death, each patient had a CATopsy performed, which was a noncontrast whole body scan. The patient then underwent an autopsy. These results were compared with those generated by the CATopsy. RESULTS: There were 12 patients enrolled in the study; average Injury Severity Scores was 33.5 +/- 19.0. In 10 of the 12 cases (83%), the CATopsy successfully indicated cause of death when compared with the autopsy. Seven of the 12
 (58%) CATopsies demonstrated air in various parts of the circulatory system, including the heart in four cases. Five of the 12 (42%) patients had clinically significant findings (including the presence of an esophageal intubation) noted on the CATopsy not previously identified on any radiographic studies or on the autopsy. These findings were addressed as part of our performance improvement process. CONCLUSION: This study suggests that a postmortem imaging test, a CATopsy, can be used to determine cause of death in trauma patients. Beyond offering a noninvasive alternative to autopsy, it provides similar information to that provided in postmortem examination and may be used in trauma performance improvement activities.

Rofo. 2005 Jan;177(1):130-6. Links
[Value of postmortem computed tomography in comparison to autopsy]
[Article in German]

Paperno S, Riepert T, Krug B, Rothschild MA, Schultes A, Staak M, Lackner L.
Klinik und Poliklinik für Radiologische Diagnostik, Universität zu KöIn. spaperno at smail.rrz.uni-koeln.de
PURPOSE: To assess the diagnostic value of postmortem computed tomography (CT) in comparison to autopsy. MATERIALS AND METHODS: Twenty-seven cadavers were examined by sequential cranial CT and helical CT through the neck, thorax and abdomen and subsequently underwent an autopsy with histomorphologic examination of the pathologic specimens. The findings of CT, autopsy and histology were registered and compared by three radiologists and one specialist for forensic medicine, using a data entry form. RESULTS: In 19 of 27 cases, the findings explaining the cause of death were concordant for CT and autopsy. Intracranial, intraspinal and intracardiac gas accumulations (n = 12) were registered by CT alone. The detection of skull fractures was equal for both methods (n = 3). CT showed diagnostic problems in the assessment of pneumonic infiltrations (n = 16) and pulmonary edema (n = 21). CONCLUSION: CT is a useful and complementary method to autopsy.

Oher papers via pubmed:

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&DbFrom=pubmed&Cmd=Link&LinkName=pubmed_pubmed&LinkReadableName=Related%20Articles&IdsFromResult=15657832&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA

Ivan Hronek MD 
SFMC, Los Angeles
cell: 310 487-3288
http://health.groups.yahoo.com/group/Anesthideas/
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P Please don't print this e-mail unless you really need to.

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----- Original Message ----
From: "Robert A. Fink, M. D." <rafink at attglobal.net>
To: ccm-l at ccm-l.org
Sent: Monday, April 21, 2008 3:37:50 PM
Subject: Re: [ccm-l] is autopsy mandatory in unsupervised or cause of death unkown in ...

On 21 Apr 2008 at 17:01, KMATTOX at aol.com wrote:

> The ME or JP can release the body in such cases,  back to the hospital
> for an autopsy to be performed by a pathologist if the  family approves
> and a mechanism exists.  

The number of hospital-based autopsies is currently a travesty.  Autopsies 
were very important during my training and we learned a great deal about 
pathology and surgery by attending autopsies.  Our service had a close to 
100% rate of autopsies on patients who died on our service and our pathology 
Museum was one of the best around  (Neuropathology was a division of the 
Neurosurgery Department at the University of Chicago, this following an old 
tradition set by such great neurosurgeons as Cushing, Dandy, Bailey, Bucy, 
and others, all of whom were pioneers in neuropathology).  We even had 
many autopsies on patients who died as out-patients and who were brought 
into the hospital for autopsy after death.

Nowadays, nobody pays for autopsies and I haven't been to an autopsy in 
probably 5 years.  Much is the shame.

Best,

Bob

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Robert A. Fink, M. D., F.A.C.S., P. C.
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Berkeley, California  94704-2636
Telephone:  510-849-2555  FAX:  510-849-2557
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