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"CATopsy" - postmortem CT.

McSwain, Norman E Jr. nmcswai at tulane.edu
Tue Feb 26 15:17:40 GMT 2008


Two points

 

1)      I continue to note that CT scans and even more FAST exams are
often wrong. I opened a chest recently because of a wrong FAST. VOMIT as
Ken would say. Clinical integration without depending on one test is by
far the best way of taking care of the patient.

2)      Our coroner sells the results of the Post Mortem to the lawyers
involved, so at our trauma committee/peer review we must jump through
special hoops to get the results of the post. It NEVER becomes part of
the patient record. Good Louisiana politics, just like Hugy Long taught
us in the 1930's and we used so successfully during Hurricane Katrina
:>)

 

Norman

 

Norman McSwain Jr, MD FACS

Trauma Director Charity Hospital

Professor of Surgery

Tulane University School of Medicine

504 988 5111

 

From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Sise, Mike MD
Sent: Tuesday, February 26, 2008 8:06 AM
To: Trauma & Critical Care mailing list
Subject: RE: "CATopsy" - postmortem CT.

 

I guess we are spoiled in San Diego where County government bears the
cost to perform post mortems in death from trauma. Results are available
as soon as the toxicology is ready. We present our deaths from three
months earlier with a dictation that includes the post mortem findings
at our Medical Audit Committee. There are consistently missed injuries,
many of importance - often in the multi-system injured who have long ICU
stays. Like many of you, I am impressed at how much we rely on CT scans
which often mislead us. One look is worth a thousand guesses.

 

Mike Sise

San Diego

 

________________________________

From: Ronald Gross [mailto:Rgross at harthosp.org]
Sent: Tue 2/26/2008 3:46 AM
To: Trauma & Critical Care mailing list
Subject: Re: "CATopsy" - postmortem CT.

>>"the hospital will have to swallow the costs"<<
I want to work where you work.  Some hospitals balk at paying physician
salaries because there are some folks that don't understand why, in a
Level I trauma center, the docs have to get paid even if they aren't
seeing patients the entire time they are in house.  So, do you think
they would pay the cost of a procedure that won't help the bottom
line????

Good luck with that one,
Ron


>>> Ivan Hronek <ivanhronek at yahoo.com> 2/25/2008 5:06 PM >>>
the hospital will have to swallow the costs - there's not that many
sudden deaths that need to be explained and not all of them would get
the CT scan.
It would be a great source of quality imrpovement and education - in the
paper they found esophageal intubation - imagine that !

Ivan Hronek MD
SFMC, Los Angeles
cell: 310 487-3288
http://health.groups.yahoo.com/group/Anesthideas/
Don't fight darkness. Bring the light, and darkness will disappear.
Maharishi Mahesh Yogi



Confidentiality Notice: This transmission and any attached documents may
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responsible in any way for procedures or approaches perfomed in the way
suggested in this note.







----- Original Message ----
From: Ronald Gross <Rgross at harthosp.org>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Monday, February 25, 2008 7:17:20 AM
Subject: Re: "CATopsy" - postmortem CT.

That would be ideal, but - and I hate to sound like this - who is going
to pay the cost of said CT postmortem exam?

Ron

>>> Ivan Hronek <ivanhronek at yahoo.com> 2/25/2008 9:26 AM >>>
Any way to instititute CATopsy - that would be great self-education -
immediately learning the cause of death !
We rarely are allowed to do any autopsies and then when the results come
8 months later noone remembers the case anymore.

Fulltext  |  PDF (558 K)
Postmortem Computed Tomography, "CATopsy", Predicts Cause of Death in
Trauma Patients.

Original Articles
Journal of Trauma-Injury Infection & Critical Care. 63(5):979-986,
November 2007.
Hoey, Brian A. MD; Cipolla, James MD; Grossman, Michael D. MD; McQuay,
Nathaniel MD; Shukla, Pratik R. MD; Stawicki, Stanislaw P. MD; Stehly,
Christy BS; Hoff, William S. MD
Abstract:
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.

Ivan Hronek MD
SFMC, Los Angeles
cell: 310 487-3288
http://health.groups.yahoo.com/group/Anesthideas/
Don't fight darkness. Bring the light, and darkness will disappear.
Maharishi Mahesh Yogi



Confidentiality Notice: This transmission and any attached documents may
be confidential and contain information protected by State and Federal
Medical Privacy statutes and is legally privileged. They are intended
for use only by the addressee. If you are not the intended recipient of
this transmission, or an agent of the intended recipient, you are
prohibited from reading, disclosing, printing, saving, copying, using,
or otherwise disseminating any information contained in this
transmission. If you received this transmission in error, please accept
our apologies and notify me at  ivanhronek at yahoo.com and delete the
entire message and its attachments. Thank you. Disclaimer: this message
contains the personal views of the author. The author will not be
responsible in any way for procedures or approaches perfomed in the way
suggested in this note.







----- Original Message ----
From: "Sise, Mike MD" <Sise.Mike at scrippshealth.org>
To: trauma-list at trauma.org
Sent: Monday, February 25, 2008 4:50:18 AM
Subject: RE: trauma-list Digest, Vol 56, Issue 28

This case re-emphasizes the importance of post-mortem examination
following every death from injury. Even the most aggressive and
comprehensive pre-mortem CT or MRI imaging can substitute for the old
fashion autopsy. We can speculate until our next birthdays, there is no
answer without a post-mortem. In San Diego, we don't present our deaths
to our system wide Medical Audit Committee until the post-mortem results
are ready and a member of the County Medical Examiner's physician staff
joins us for the discussion.

Mike Sise
San Diego

________________________________

From: trauma-list-bounces at trauma.org on behalf of
trauma-list-request at trauma.org
Sent: Mon 2/25/2008 4:00 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 56, Issue 28



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