Department of Radiology and Nuclear Medicine, Maastricht UMC, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
Department of Pathology, Maastricht UMC, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
Int J Environ Res Public Health. 2020 Oct 18;17(20):7572. doi: 10.3390/ijerph17207572.
The current literature describing the use of minimally invasive autopsy in clinical care is mainly focused on the cause of death. However, the identification of unexpected findings is equally important for the evaluation and improvement of daily clinical care. The purpose of this study was to analyze unexpected post-mortem computed tomography (PMCT) findings of hospitalized patients and assess their clinical relevance. This observational study included patients admitted to the internal medicine ward. Consent for PMCT and autopsy was requested from the next of kin. Decedents were included when consent for at least PMCT was obtained. Consent for autopsy was not obtained for all decedents. All findings reported by PMCT were coded with an International Classification of Diseases (ICD) code. Unexpected findings were identified and subsequently categorized for their clinical relevance by the Goldman classification. Goldman class I and III were considered clinically relevant. Additionally, correlation with autopsy results and ante-mortem imaging was performed. : In total, 120 decedents were included and evaluated for unexpected findings on PMCT. Of them, 57 decedents also underwent an autopsy. A total of 1020 findings were identified; 111 correlated with the cause of death (10.9%), 508 were previously reported (49.8%), 99 were interpreted as post-mortem changes (9.7%), and 302 were classified as unexpected findings (29.6%). After correlation with autopsy (in 57 decedents), 24 clinically relevant unexpected findings remained. These findings were reported in 18 of 57 decedents (32%). Interestingly, 25% of all unexpected findings were not reported by autopsy. Many unexpected findings are reported by PMCT in hospitalized patients, a substantial portion of which is clinically relevant. Additionally, PMCT is able to identify pathology and injuries not reported by conventional autopsy. A combination of PMCT and autopsy can thus be considered a more comprehensive and complete post-mortem examination.
目前描述微创尸检在临床护理中应用的文献主要集中在死因上。然而，意外发现的识别对于评估和改善日常临床护理同样重要。本研究旨在分析住院患者死后计算机断层扫描（PMCT）的意外发现，并评估其临床相关性。
这项观察性研究纳入了内科病房收治的患者。向家属请求 PMCT 和尸检同意。只有至少获得 PMCT 同意的死者才被纳入。并非所有死者都获得了尸检同意。PMCT 报告的所有发现均用国际疾病分类（ICD）代码编码。通过 Goldman 分类法识别意外发现，并随后对其临床相关性进行分类。 Goldman 分类法 I 类和 III 类被认为具有临床相关性。此外，还进行了与尸检结果和生前影像学的相关性分析。
总共纳入了 120 名死者，并对 PMCT 上的意外发现进行了评估。其中，57 名死者还进行了尸检。共发现 1020 个发现；111 个与死因相关（10.9%），508 个以前有报道（49.8%），99 个被解释为死后变化（9.7%），302 个被归类为意外发现（29.6%）。与尸检（57 例死者）相关后，仍有 24 个具有临床相关性的意外发现。这些发现报告在 18 例死者（32%）中。有趣的是，所有意外发现中有 25%未在尸检中报告。
许多意外发现是通过 PMCT 在住院患者中报告的，其中相当一部分具有临床相关性。此外，PMCT 能够识别常规尸检未报告的病理和损伤。因此，PMCT 和尸检的结合可以被认为是一种更全面和完整的死后检查。
