Utility of Whole-Body CT Imaging in the Post Mortem Detection of Elder Abuse and Neglect: Comparison with and Potential Substitution for Standard Autopsy.

Abuse and neglect of elderly individuals in residential care are escalating along with the increasing number of older individuals in the United States. Although abuse and neglect have been well defined in the medical and legal literature, identification of all but the most egregious incidents remains a challenge. Public exposure of abuse and neglect has created an atmosphere of suspicion, with many families fearing the worst when loved ones die in residential care. The result is growing pressure on medical examiners (MEs) to perform complete autopsies on decedents who would once have received simple visual inspection and death certificates. Law enforcement and advocacy groups, too, are lobbying for routine autopsy to discover possible elder abuse and homicide. Yet most MEs are ill equipped to handle the extraordinary increase in workloads that such autopsies would require. The applicants propose a project to assess the utility of a noninvasive medical imaging protocol in providing accurate, rapidly available information to aid the ME in the detection or exclusion of abuse/neglect. This 3-phase project would be realized through an established partnership between the University of Maryland's Department of Diagnostic Radiology and the Maryland Office of the Chief ME. Phase 1 will be a proof-of-concept double-blind study including 30 decedents (>=65 years old) in whom residential care abuse/neglect is suspected. Each will undergo routine external examination by the ME, whole-body CT imaging interpreted by diagnostic radiologists, and complete autopsy. The sensitivity, specificity, and accuracy of CT for indications of abuse/neglect will be compared with autopsy findings. Phase 2 will include 50 decedents (>=65 years old) in whom residential or long-term care abuse/neglect is suspected. Each will undergo a noninvasive protocol comprising external medical examination and CT imaging to determine the presence of suspicious findings. Decedents with suspicious findings will proceed to complete autopsy. The results will be evaluated for: relative duration and cost of the noninvasive imaging protocol and autopsy, and number of autopsies avoided or facilitated using the results of the noninvasive protocol. Phase 3 will include preparation of a series of publications, presentations, and project dissemination materials, including a white paper to be released in electronic format with a database of accompanying images for medical examiners who wish to replicate these findings and incorporate CT imaging into routine assessment of elder abuse and neglect. ca/ncf