This study examined the potential for using whole-body, postmortem computed tomography (PMCT) with elderly decedents as a triage tool for determining the need for conventional autopsy based on PMCT's detection of injuries suggestive of physical abuse and/or neglect.
The study found that PMCT agreed with conventional autopsy findings regarding the presence or absence of elder abuse in 100 percent of the cases; evidence suggestive of elder abuse was present in one case, and such evidence was absent in 57 cases. In the one case suggestive of elder abuse, PMCT detected multiple unreported fractures of varying ages. Other notable findings were acute rib fracture with patterns consistent cardiopulmonary resuscitation in 21 (36 percent) of decedents. PMCT detected these injuries in 20 of 21 cases, and autopsy detected them in 11 of 21 cases. Other musculoskeletal pathology overlooked at PMCT included a cervical and rib fracture; and overlooked at autopsy were a cervical spine, hip, clavicle, and two sternal fractures. PMCT missed superficial decubitus ulcers in 9 of 17 cases, but was more accurate than autopsy for characterization of deeper stage-four ulcers with osteomyelitis or abscess complications. Cause of death was determined by conventional autopsy in all 58 cases, but PMCT determined cause of death in only 24 (41 percent) cases. In correlation with clinical history, scene investigation, toxicology, and external examination, PMCT may be used as a triage tool in determining the need for conventional autopsy in such cases. The study included 58 decedents with a mean age of 76 years, all of whom were referred to the Office of the Chief Medical Examiner for Maryland following allegations of elder abuse.
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