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Impact of the COVID-19 pandemic on a post-mortem CT service for adult non-suspicious death

Version 2 2024-03-11, 15:16
Version 1 2023-11-23, 10:15
journal contribution
posted on 2024-03-11, 15:16 authored by J James, C Robinson, C Mason, C Richards, K West, B Morgan

Due to the COVID-19 pandemic, the post-mortem computed tomography (PMCT) service was expanded from three to seven cases per day to help mortuary services and avoid invasive autopsy. Additional targeted angiography and pulmonary ventilation procedures were stopped and triage rules relaxed to allow more indications to be scanned, including those requiring toxicology. A service evaluation was performed for the first 3-months of the COVID-19 pandemic compared to the equivalent period the previous year to study the impact of these changes. It was found that, despite the increase in deaths regionally, coronial referrals remained about 100 per month, a reduction in referral rate. The number undergoing PMCT rose from 28% to 74% of cases. Turnaround time remained the same. For cases triaged to PMCT, the need for subsequent autopsy increased from 7.9% to 15.8%. No significant changes were seen in diagnosis rates, including cardiac or respiratory. There was an increase in patients with coronary death without severe coronary calcification who underwent autopsy after PMCT. These may have been diagnosed by targeted coronary angiography. Fifty-three cases requiring toxicology/biochemistry had PMCT, with 38 having PMCT only. In 8/11 (72.7%) cases with normal PMCT and toxicology as the key diagnostic test, autopsy was performed prior to results. This suggests the pathology team were reluctant to risk an “unascertained” outcome. This study shows that it is possible to increase PMCT services by widening referral criteria and by limiting the use of enhanced imaging techniques, without significantly changing diagnosis rates of key diseases; however, selectively restarting targeted angiography may help avoid autopsy in some cases.

History

Author affiliation

College of Life Sciences, University of Leicester

Version

  • AM (Accepted Manuscript)

Published in

Clinical Radiology

Volume

78

Issue

11

Pagination

822 - 831

Publisher

Elsevier BV

issn

0009-9260

eissn

1365-229X

Copyright date

2023

Available date

2024-08-14

Spatial coverage

England

Language

eng

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