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Investigators from multiple institutions conducted a retrospective study to assess the diagnostic yield of postmortem imaging (PMI) in young children after sudden unexpected death. For the study, they included children <24 months old who presented to the pediatric ED of a freestanding urban children’s hospital in the US after unexpected cardiopulmonary arrest and were subsequently pronounced dead between 2008 and 2018. The institutional mortality registry was used to identify age-eligible children with ICD-9 or ICD-10 codes for sudden infant death syndrome or death of unknown causes. The medical records of these children were reviewed; those with a traumatic cause of death (eg, gunshot wound, motor vehicle accident) were excluded. For the included children, demographic information, physical examination findings, autopsy findings, and type of PMI (skeletal survey, head CT, whole-body CT) and results were abstracted. Physical examination findings were classified as negative, nontraumatic, or traumatic if there were signs of abuse. PMI results were classified as negative, nontraumatic, or traumatic (eg, if fractures were present). If an autopsy was performed, the cause and nature of death, as determined by the medical examiner, was reported. For the analyses, study participants were classified as infants (<13 months old) or young children (13-24 months old). The frequency of traumatic PMI results among children whose physical examination findings were consistent with abuse was calculated. Similarly, the frequency of fractures identified by PMI in children with negative physical examinations also was determined.
Data were analyzed on 150 children with sudden unexpected death during the 10-year study period. Among these, 128 (85.3%) were infants (≤12 months old), and 83 (55.3%) were male. Autopsies were obtained in 128 study participants. The most common cause of death in these children was asphyxia (N = 63; 49.2%); the manner of death was classified as accidental in 66 (51.1%), natural in 25 (19.2%), indeterminate in 23 (18.0%), and homicide in 14 (10.9%). PMI was obtained on 130 study participants (86.7%), including skeletal surveys in 72%, head CT in 44.6%, and whole-body CT in 26%. Overall, PMI yielded additional findings (non-traumatic or traumatic) in 51 infants (34%) and 13 young children (59.1%). Among 10 infants with physical examination findings consistent with abuse, there were 5 with traumatic findings on PMI, and in 7 young children, 13-24 months old, with evidence of abuse on physical examination, 4 had traumatic PMI results. There were 11 patients, all ≤12 months old, with negative physical examinations who had fractures and/or healing fractures on PMI.
The authors conclude that PMI was useful in identification of additional findings, especially in those with negative physical examinations.
Dr Bechtel has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Child maltreatment...
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