Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice.
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):252-7. doi: 10.-013-2804-0. Epub
2013 Nov 8.Routine perinatal and paediatric post-mortem radiography: detection rates and implications for practice.1, , , , .1Department of Radiology Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK, owen.arthurs@gosh.nhs.uk.AbstractBACKGROUND: Routine perinatal and paediatric post-mortem plain radiography allows for the diagnosis and assessment of skeletal dysplasias, fractures and other bony abnormalities.OBJECTIVE: The aim of this study was to review the diagnostic yield of this practice.MATERIALS AND METHODS: We identified 1,027 cases performed in a single institution over a 2 1/2 -year period, including babygrams (whole-body examinations) and full skeletal surveys. Images were reported prior to autopsy in all cases. Radiology findings were cross-referenced with the autopsy findings using an autopsy database. We scored each case from 0 to 4 according to the level of diagnostic usefulness.RESULTS: The overall abnormality rate was 126/1,027 (12.3%). There was a significantly higher rate of abnormality when a skeletal survey was performed (18%) rather than a babygram (10%; P & 0.01); 90% (665/739) of babygrams were normal. Of the 74 abnormal babygrams, we found 33 incidental non-contributory cases, 19 contributory, 20 diagnostic, and 2 false-positive cases. There were only 2 cases out of 739 (0.27%) in whom routine post-mortem imaging identified potentially significant abnormalities that would not have been detected if only selected imaging had been performed. A policy of performing selected, rather than routine, foetal post-mortem radiography could result in a significant cost saving.CONCLUSION: Routine post-mortem paediatric radiography in foetuses and neonates is neither diagnostically useful nor cost-effective. A more evidence-based, selective protocol should yield significant cost savings.PMID:
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