6 research outputs found
Detection of bacterioplankton using PCR probes as a diagnostic indicator for drowning; the Leicester experience
Diagnostic accuracy of post-mortem CT with targeted coronary angiography versus autopsy for coroner-requested post-mortem investigations: a prospective, masked, comparison study.
England and Wales have one of the highest frequencies of autopsy in the world. Implementation of post-mortem CT (PMCT), enhanced with targeted coronary angiography (PMCTA), in adults to avoid invasive autopsy would have cultural, religious, and potential economic benefits. We aimed to assess the diagnostic accuracy of PMCTA as a first-line technique in post-mortem investigations.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site
Post-mortem computed tomography visualised fire related post-mortem changes of the head
As post-mortem computed tomography (PMCT) becomes more routinely utilised
in day-to-day autopsy practice around the world it is important that those
reporting the images are aware of changes that may not be encountered in
clinical radiology that can result in the post-mortem period but resemble
antemortem pathology. Two cases are presented to illustrate the PMCT findings
of three of the four classical changes that occur to the head after death as a result
of the effect of prolonged exposure to heat
Detection of bacterioplankton using PCR probes as a diagnostic indicator for drowning; the Leicester experience.
Bodies found immersed in water can pose difficulties to the investigating authorities. Pathologists
may be assisted with the diagnosis by the use of tests such as the analysis for diatoms or the levels
of strontium in the blood, although there is a recognised level of uncertainty associated with these
tests. Recent work from Japan has shown that using molecular approaches, most recently real-time
polymerase chain reaction (PCR) assays with TaqMan probes for bacterioplankton, it is possible to
undertake rapid, less laborious, high throughput tests to differentiate freshwater from marine
bacterioplankton and in doing so provide a molecular diagnostic test to assist in the diagnosis of
drowning. We report the experiences of a United Kingdom forensic pathology unit in the use of this
PCR based system for the diagnosis of drowning. We applied this technique to 20 adult and child
cadavers from 4 bath, 12 freshwater, 2 brackish and 2 salt water scenes both from within the United
Kingdom and abroad. Drowning was concluded to be the cause of death in 16 of these 20 cases and
the PCR method supported this conclusion in 12 of these 16 cases. The PCR did not provide evidence
of drowning in the four cases where death was from other causes. We illustrate that this PCR
method provides a rapid diagnostic supportive test for the diagnosis of drowning that can be applied
to United Kingdom autopsy practice
The role of histology in forensic autopsies: Is histological examination always necessary to determine a cause of death?
Diagnostic accuracy of post-‐mortem Computed Tomography with targeted Coronary Angiography (PMCTA) when used as the first-‐line investigation for HM Coroner post-‐mortem investigations: prospective, blind comparison to a gold standard study.
Background
England and Wales have one of the highest frequencies of autopsy in the world. Implementation of post-mortem CT (PMCT), enhanced with targeted coronary angiography (PMCTA), in adults to avoid invasive autopsy would have cultural, religious, and potential economic benefits. We aimed to assess the diagnostic accuracy of PMCTA as a first-line technique in post-mortem investigations.
Methods
In this single-centre (Leicester, UK), prospective, controlled study, we selected cases of natural and non-suspicious unnatural death referred to Her Majesty's (HM) Coroners. We excluded cases younger than 18 years, known to have had a transmittable disease, or who weighed more than 125 kg. Each case was assessed by PMCTA, followed by autopsy. Pathologists were masked to the PMCTA findings, unless a potential risk was shown. The primary endpoint was the accuracy of the cause of death diagnosis from PMCTA against a gold standard of autopsy findings, modified by PMCTA findings only if additional substantially incontrovertible findings were identified.
Findings
Between Jan 20, 2010, and Sept 13, 2012, we selected 241 cases, for which PMCTA was successful in 204 (85%). Seven cases were excluded from the analysis because of procedural unmasking or no autopsy data, as were 24 cases with a clear diagnosis of traumatic death before investigation; 210 cases were included. In 40 (19%) cases, predictable toxicology or histology testing accessible by PMCT informed the result. PMCTA provided a cause of death in 193 (92%) cases. A major discrepancy with the gold standard was noted in 12 (6%) cases identified by PMCTA, and in nine (5%) cases identified by autopsy (because of specific findings on PMCTA). The frequency of autopsy and PMCTA discrepancies were not significantly different (p=0·65 for major discrepancies and p=0·21 for minor discrepancies). Cause of death given by PMCTA did not overlook clinically significant trauma, occupational lung disease, or reportable disease, and did not significantly affect the overall population data for cause of death (p≥0·31). PMCTA was better at identifying trauma and haemorrhage (p=0·008), whereas autopsy was better at identifying pulmonary thromboembolism (p=0·004).
Interpretation
For most sudden natural adult deaths investigated by HM Coroners, PMCTA could be used to avoid invasive autopsy. The gold standard of post-mortem investigations should include both PMCT and invasive autopsy.
Funding
National Institute for Health Research