"CATopsy" - postmortem CT.

Tue Feb 26 14:58:37 GMT 2008

Mike

South Africa has a national PM for all unnatural deaths policy. Unfortunately we don't always get the feedback on the missed injuries identified (when they are picked up). All unnatural deaths are transferred to the "police mortuary" where a state pathologist will do a physical and histological PM within 72 hours. Tox may take longer.

Tim
Dr T C Hardcastle 
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA) 
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) 
ATLS  instructor and DSTC Cape Town Course Director 
Intern program Coordinator: Surgery 
M.Med (Emergency Medicine) Executive Committee member 
Clinical Head (Director): Diana Princess of Wales Trauma Unit 
Division of Surgery (General) Room 4064 
Department of Surgical Sciences 
Tygerberg Hospital / University of Stellenbosch 
PO Box 19063 
Tygerberg 7505 
Western Cape 
South Africa 
e-mail: tch at sun.ac.za 
Cell: +27824681615 
Office: +27219389281 or 4911 pager 0302 

-----Original Message-----
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 4:06 PM
To: Trauma &amp; 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 &amp; 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 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: 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

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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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