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Postmortem computed tomography plus forensic autopsy for determining the cause of death in child fatalities

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Pediatric Radiology Aims and scope Submit manuscript

A Correction to this article was published on 09 August 2022

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Abstract

Background

Postmortem computed tomography (CT) and magnetic resonance imaging have been gradually introduced to forensic pathology centres over the past two decades, with varying results in comparison to autopsy.

Objective

The purpose of this study was to determine the accuracy of postmortem CT in determining a cause of death in children who died of unnatural causes.

Materials and methods

This was a prospective recruitment of 30 children (< 18 years) who underwent postmortem CT and a forensic autopsy. A cause of death was independently assigned by two experienced paediatric radiologists and compared to that of the forensic autopsy.

Results

A correct cause of death was assigned by reviewers 1 and 2 in 70% (n = 21/30) and 67% (n = 20/30) of cases, respectively. For gunshot injuries and blunt force head injuries, there was 91% (n = 10/11) and 100% (n = 6/6) agreement between forensic autopsy and both reviewers, respectively. No cause of death could be assigned by reviewers 1 and 2 in 27% (n = 8) and 30% (n = 9) of cases, respectively. An incorrect cause of death was assigned by both reviewers in one case (3%). The Cohen Kappa level of agreement between the forensic autopsy and reviewers 1 and 2 was k = 0.624 (95% confidence interval [CI]: 0.45–0.80, P = 0) and k = 0.582 (95% CI 0.41–0.76, P = 0), respectively. There was near perfect agreement between reviewers 1 and 2 (k = 0.905) (95% CI 0.78–1.00, P = 0).

Conclusion

Postmortem CT has good diagnostic accuracy for identifying a cause of death related to trauma, but it has poor accuracy for children dying from causes not associated with apparent physical injury.

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Acknowledgements

This study was approved by the Human Research Ethics Committee of the University of Cape Town and all relevant ethical requirements were upheld in accordance with the Declaration of Helsinki (1964) and later amendments

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Authors and Affiliations

  1. Radiography (Diagnostic), Department of Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, 7530, Cape Town, South Africa

    Aladdin C. Speelman

  2. Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville, 7530, Cape Town, South Africa

    Penelope C. Engel-Hills

  3. Division of Forensic Medicine & Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    Lorna J. Martin

  4. Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Rick R. van Rijn

  5. Department of Forensic Medicine, Netherlands Forensic Institute, The Hague, The Netherlands

    Rick R. van Rijn

  6. University of Sheffield and Sheffield Children’s NHS Foundation Trust, Sheffield, UK

    Amaka C. Offiah

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Correspondence to Aladdin C. Speelman.

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The original online version of this article was revised: The correct contact information for Lorna J. Martin is: 3 Division of Forensic Medicine & Toxicology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa The correct keywords are: Keywords Autopsy · Cause of death · Child fatalities · Children · Computed tomography · Forensic · Postmortem

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Speelman, A.C., Engel-Hills, P.C., Martin, L.J. et al. Postmortem computed tomography plus forensic autopsy for determining the cause of death in child fatalities. Pediatr Radiol 52, 2620–2629 (2022). https://doi.org/10.1007/s00247-022-05406-7

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